两孔法、三孔法阑尾切除术的对比研究

目的对比研究两孔法、三孔法阑尾切除术。讨论两孔法阑尾切除术的手术适应证。方法对比研究两孔、三孔阑尾切除术的手术时间、术后恢复、并发症情况。结果腹腔镜阑尾切除术在手术时间、手术恢复时间及切口感染率上均明显优于开腹阑尾切除术，两孔法阑尾切除术相对于三孔法阑尾切除术无明显优势。化脓性阑尾炎两孔LA切口感染率明显高于三孔LA。结论两孔LA手术适应证应限于单纯性阑尾炎及慢性阑尾炎。     

腹腔镜脐部单孔法阑尾切除术168例临床分析

目的探讨经脐单孔腹腔镜阑尾切除术的临床疗效。方法对168例施行经脐单孔腹腔镜阑尾切除术的阑尾炎患者进行回顾性分析。结果 168例患者中,132例行单孔法腹腔镜手术获得成功;31例经脐向右下腹延长切口而行开放式手术;5例另做右下腹经腹直肌切口而完成手术。手术时间27～105分钟,平均40分钟。术后常规抗炎治疗,其中出现10例切口部位感染,接受随访的160例患者无其他并发症。168例患者均痊愈出院,平均住院天数为5.5天。结论经单孔法腹腔镜手术较传统的开刀手术具有损伤小、痛苦少、恢复快、因切口位于隐蔽的脐部利于患者腹部美容等优点。同时腹腔镜阑尾切除术易于掌握,简单易行,在各个层次医院具有广泛的使用推广性。     

经脐单孔腹腔镜阑尾切除术47例

目的 探讨经脐单孔腹腔镜阑尾切除术治疗成人急、慢性阑尾炎的临床应用价值.方法 2008年10月～2010年1月选择性对47例成人急、慢性阑尾炎患者实施经脐单孔腹腔镜阑尾切除术,观察记录相关临床资料进行分析.结果 47例患者中46例顺利完成经脐单孔腹腔镜阑尾切除术手术,1例因粘连严重中转为三孔法操作,平均手术时间(38.4±16.4)min,无腹腔及切口感染,腹部无明显手术瘢痕;术后随访6～12个月,无粘连性肠梗阻、脐疝及阑尾残株炎等并发症出现.结论 经脐单孔腹腔镜阑尾切除术安全可行,具有微创、美观、疗效确切等优点,是治疗成人阑尾炎的理想术式.     

经脐单孔悬吊固定阑尾切除术对阑尾炎患者术后疼痛及炎症反应的影响

目的 探究经脐单孔悬吊固定阑尾切除术对阑尾炎患者术后疼痛及炎症反应的影响。方法 选取2019年5月至2022年6月我院收治的80例阑尾炎患者，采用随机数字表法分为对照组和观察组各40例。对照组采用常规三孔腹腔镜阑尾切除术（LA）治疗，观察组采用经脐单孔悬吊固定阑尾切除术治疗。比较两组手术指标、疼痛程度及炎症反应。结果观察组术后排气时间、住院时间短于对照组（P<0.05）；术后1 d，两组视觉模拟评分法（VAS）评分均低于术前，且观察组低于对照组（P<0.05）；两组C反应蛋白（CRP）、肿瘤坏死因子-ɑ（TNF-ɑ）低于术前，且观察组低于对照组（P<0.05）。结论 经脐单孔悬吊固定阑尾切除术治疗阑尾炎，可以缩短患者术后恢复时间，减轻患者的疼痛程度及炎症反应，值得推广。     

经脐单孔法腹腔镜阑尾切除术临床应用分析

目的:探讨经脐单孔法腹腔镜阑尾切除术的临床应用价值。方法:选择我院2011年3月²013年4月收治的60例阑尾炎患者为研究对象,均行经脐单孔法腹腔镜阑尾切除术治疗,分析其临床疗效。结果:所有患者均顺利完成经脐单孔法腹腔镜阑尾切除术,术后均10 h内肛门排气,手术时间平均15 min,术后平均住院时间4 d;所有患者均未发生并发症,手术无明显疤痕。结论:经脐单孔法腹腔镜阑尾切除术结合了腹腔镜手术与开腹手术的优势,其微创且安全性能高,腹部无可视伤痕,术后美容效果佳,可取得良好的恢复效果,且缩短伤口恢复时间。     

LA和OA治疗小儿急性化脓性阑尾炎的疗效和安全性比较

目的探讨经脐单孔腹腔镜下阑尾切除术(LA)和开腹阑尾切除术(OA)治疗小儿急性化脓性阑尾炎的疗效和安全性。方法选取收治的急性化脓性阑尾炎患儿92例,按手术治疗方式的不同分为LA组和OA组各46例。对比两组术前及术后1d炎症指标[白细胞计数及C反应蛋白(CPR)]与术后并发症发生情况,并记录两组手术相关指标及术后康复情况。结果 LA组手术时间、切口长度、术中出血量、住院时间、术后止痛次数显著低于OA组(P<0.05);术后两组IL-6、IL-8、CPR水平较术前明显增高,而LA组炎症指标水平低于OA组(P<0.05);术后,LA组并发症发生率较OA组更低(10.87%vs 28.26%,P<0.05)。结论较OA而言,小儿急性化脓性阑尾炎行LA安全性更高,不仅有效控制术后炎性反应发生,还可加快患儿术后的康复。     

单孔与三孔腹腔镜阑尾切除术疗效对照观察

目的探讨单孔与三孔腹腔镜阑尾切除术的临床疗效。方法将123例急性阑尾炎患者按手术方式不同分为研究组62例,对照组61例。研究组给予单孔腹腔镜阑尾切除术治疗,对照组给予三孔腹腔镜阑尾切除术治疗,术后两组均给予左氧氟沙星治疗。比较两组肠功能恢复时间、术后首次下床时间、止痛药使用次数、住院时间,以及术后并发症发生率和切口满意度。结果研究组肠功能恢复时间、术后首次下床时间显著早于对照组(P<0.01),止痛药使用次数显著少于对照组(P<0.01),住院时间显著短于对照组(P<0.01)。两组并发症发生率比较差异无统计学意义(P>0.05),研究组切口总满意率显著高于对照组(P<0.05)。结论单孔腹腔镜阑尾切除术治疗急性阑尾炎效果显著,更利于患者术后恢复,减少止痛药使用次数,提高切口满意度。     

经腹腔镜阑尾切除术50例临床体会

目的 探讨经腹腔镜阑尾切除术(LA)的安全性.方法 阑尾炎患者50例,其中单纯性阑尾炎18例,化脓性阑尾炎15例,阑尾坏疽、穿孔10例,阑尾炎症性包块5例,阑尾黏液囊肿2例.采用"三孔法",完全腹腔镜手术30例;麦氏点套管鞘处延长切口(辅助小切口)10例;经脐孔拉出10例.阑尾残端荷包包埋24例.阑尾残端用套圈套扎26例.结果 50例均治愈,无中转手术,手术时间15～35 min,住院2～5 d;切口感染2例,其中1例脐孔感染治愈后1个月并发脐孔疝,另1例炎症性包块术后2个月引流管形成慢性窦道,再次剖腹炎症性包块诊断为回盲部恶性肿瘤行右半结肠切除术.结论 LA具有手术时间短、住院时间短、并发症少及腹部瘢痕小等优点,值得临床应用和推广.     

腹腔镜在化脓性阑尾炎手术中的应用效果

目的探讨腹腔镜在化脓性阑尾炎切除术中的应用效果。方法回顾性分析2012年1月至2014年1月期间收治的术后病理均证实为化脓性阑尾炎的患者共136例的临床资料,比较行腹腔镜阑尾切除术(LA组)75例和开腹阑尾切除术(OA组)61例患者的放置引流管情况、术后肛门排气时间、术后切口(戳孔)感染、术后住院时间等。结果 2组放置引流管例数及术后住院时间比较,LA组少于OA组,差异有统计学意义,P<0.05;2组术后肛门排气时间及术后切口(戳孔)感染例数比较,LA组少于OA组,差异无统计学意义,P>0.05。结论在化脓性阑尾炎手术中,腹腔镜要优于开腹手术,可以减少引流管放置及缩短术后住院时间。更多还原     

采用TriPort单孔腹腔镜小儿阑尾切除术的手术配合

腹腔镜阑尾切除术(laparoscopic appendectomy,LA)具有创伤小、疼痛轻、恢复快、并发症少等优点,是阑尾切除的最佳选择,已成为临床治疗急、慢性阑尾炎的首选手术方式。经脐单孔腹腔镜阑尾切除术,极大地减少了腹壁戳孔,且脐部切孔隐蔽,达到最大程度地减少创伤和术后痛苦,从而成为新的小儿阑尾炎的首选手术方式,同时对手术护理配合提出了新的要求。现将采用TriPort单孔腹腔镜小儿阑尾切除术的手术护理配合体会报告如下。     

胸腔镜单孔和三孔肺段切除对早期NSCLC的疗效及IL-8、Fractalkine、MIP-3α的影响

【目的】观察胸腔镜单孔和三孔肺段切除术对早期非小细胞肺癌(NSCLC)的治疗效果,及对患者白介素-8(IL-8)、不规则趋化因子(Fractalkine)、人巨噬细胞炎性蛋白3α(MIP-3α)水平的影响。【方法】选择在本院接受胸腔镜肺段切除术治疗的早期NSCLC患者80例,根据其手术方式分为单孔手术组和三孔手术组。观察两组手术一般情况,比较两组手术前后肺功能、IL-8、Fractalkine、MIP-3α、术后恢复和术后l年生存率的差异。【结果】单孔手术组患者的术中出血量,术后下床活动时间低于三孔手术组(P<0.05),两组患者手术时间、清扫淋巴结数目、术后拔除胸腔引流管时间相比较差异无显著性(P>0.05);两组手术前IL-8、FraCtalkine、MIP-3α水平比较差异无显著性(P>0.05);术后单孔手术组患者IL-8、Fractalkine、MIP-3α水平低于三孔手术组,且差异有显著性(P<0.05);两组患者手术前后肺功能相关指标第1秒用力呼气流量(FEV1)、用力肺活量(FVC)、最大自主通气量(M W)水平相比较差异无显著性(P>0.05);两组患者1年生存率分别为75.00%(30/40)和72.50%(29/40),其差异无显著性(P>0.05);两组患者术后发生肺部感染、神经损伤和胸部疼痛的比例相比较差异无显著性(P>0.05)。【结论】胸腔镜单孔和三孔肺段切除术对早期NSCLC的疗效相当,但单孔手术创伤小,对IL-8、Fractalkine、M1P-3a水平改善效果好,具有良好的应用价值。     

单孔腹腔镜手术治疗卵巢囊肿的疗效观察

【目的】探讨单孔腹腔镜手术(LESS)治疗卵巢囊肿的疗效观察。【方法】选取本院拟实施腹腔镜下卵巢囊肿剔除术治疗的患者150例,采用随机数表法分为单孔组(采用LESS治疗)和三孔组(常规三孔腹腔镜手术)各75例;统计两组手术时间、出血量、术后肛门首次排气时间、住院时间、手术前后生殖激素及卵巢储备卵泡数量的变化、手术并发症。【结果】两组患者手术时间、术后肛门首次排气时间、住院时间比较差异无统计学意义(P>0.05);但单孔组术中的出血量显著低于三孔组(P<0.05);在术后2 h、6 h、12 h、24 h,单孔组的VAS评分均显著低于三孔组;两组手术前、后的血清雌激素(E2)、黄体生成素(LH)、促卵泡激素(FSH)及储备卵泡数目比较差异均无统计学意义(P>0.05)。【结论】LESS卵巢囊肿剔除术具有创伤更小、术后患者疼痛程度更轻,且对性激素水平无明显影响,值得临床推广应用。     

高频超声回盲部定位法联合血浆纤维蛋白原在小儿阑尾炎病理分型诊断中的价值探究

目的：探讨高频超声回盲部定位法联合血浆纤维蛋白原(Fibrinogen, FIB)测定对儿童的不同病理类型阑尾炎诊断的应用和价值。方法：选择2017年1月到2018年12月在本院收治的阑尾炎患儿62例,经术后病理确诊为阑尾炎者60例为阳性诊断,术中未发现阑尾有炎症或发现其它病变者为阴性诊断。术前应用高频超声回盲部定位法和FIB测定法两种方法联合进行检查,对患儿病情进行全面评价。采用 Kappa 检验分析超声检查对小儿不同病理类型阑尾炎的诊断结果的一致性;分别计算各类型阑尾炎FIB水平和联合诊断对小儿阑尾炎诊断的准确率、敏感度和特异度,并绘制ROC曲线评价联合诊断对小儿阑尾炎的诊断价值。结果：本组62例患者经手术及病理证实60例为急性阑尾炎,径超声诊断60例为急性阑尾炎,超声诊断总体符合率为100%(60/60),但超声检查对各类型阑尾炎诊断与病理诊断相比,诊断一致性一般(Kappa=0.746,P=0.000＜0.001);阑尾炎患儿FIB随着病理类型逐渐加重,各组组间比较差异具有统计学意义(P<0.05),各组阑尾炎患儿FIB水平均明显高于健康组(P<0.05);ROC曲线分析显示,FIB诊断单纯性阑尾炎、化脓性阑尾炎、坏疽性阑尾炎的曲线面积(AUC)分别为0.685、0.743、0.785;FIB对单纯性、化脓性、坏疽性阑尾炎的最佳诊断临界值分别为2.37g/L、3.68g/L、4.72g/L,此时敏感度分别为70.87%、72.59%、83.09%、75.09%;联合诊断时,单纯性阑尾炎、化脓性阑尾炎、坏疽性阑尾炎的曲线面积(AUC)分别为0.853、0.872、0.895,敏感度分别为87.50%、90.91%、95.45%,特异度分别为：75.00%、61.22%、73.68%。结论：超声技术的应用对小儿阑尾炎的诊断正确率,但对于不太典型的阑尾炎还缺乏更高的敏感性;利用高频超声回盲部定位法联合血浆纤维蛋白原水平可以进一步提高对小儿各类型阑尾炎的诊断敏感性,有助于进行及时治疗以及治疗方案的合理选择。     

Improved sonographic visualization of the appendix with a saline enema in children with suspected appendicitis.

OBJECTIVE: To determine whether abdominal sonography after a saline enema can identify the appendix that is not visualized at graded compression sonography in children with suspected appendicitis. METHODS: High-frequency compression sonography was prospectively performed in 120 consecutive children with suspected appendicitis; the appendix was not identified in 27 of these patients. Among the 27 patients with a nonvisualized appendix, abdominal sonography after a saline enema was performed in 12 to identify the appendix. RESULTS: Abdominal sonography after the saline enema revealed the appendix in all 12 children in whom the appendix was not visualized at graded compression sonography. A normal appendix was found in 11 children, and acute appendicitis confined to the appendiceal tip was found in 1. The appendix was located in the pelvis (n = 5), posterior to the cecum (n = 4), posterior to the ileum (n = 2), and anterior to the ileum (n = 1). The appendix could be identified by using a window of the saline-filled sigmoid colon (n = 5), saline-filled cecum (n = 4), and saline-filled terminal ileum (n = 2). CONCLUSIONS: Abdominal sonography after a saline enema is a helpful technique for depiction of the appendix that is not visible at graded compression sonography in children with suspected appendicitis. Key words: appendix, sonography; appendicitis; children, gastrointestinal tract.     

Different urinalysis appearances in children with simple and perforated appendicitis

PurposeThis study aimed to determine whether routine urinalysis may serve as a tool in discriminating between acute appendicitis and perforated appendicitis in children.Basic proceduresWe prospectively collected 357 patients with clinically suspected acute appendicitis. Urinalysis was performed in patients with clinically suspected acute appendicitis before surgical intervention. Routine urinalysis is composed of 2 examinations: chemical tests for abnormal chemical constituents and microscopic tests for abnormal insoluble constituents. Receiver operating characteristic curves for urine white blood cell (WBC) counts and urine red blood cell (RBC) counts in distinguishing between patients with simple appendicitis and patients with perforated appendicitis were also analyzed.Main findingsUrine ketone bodies, leukocyte esterase, specific gravity, pH, WBC, and RBC counts were all significant parameters among patients with normal appendices, simple appendicitis, and perforated appendicitis (all P < .05). Based on multivariate logistic regression analysis, positive urine ketone bodies and nitrate were significant parameters in predicting perforated appendicitis (P = .002 and P = .008, respectively). According to the results of receiver operating characteristic curves, the appropriate cutoff values were 2.0/high-power field for urine RBC counts and 4.0/high-power field for urine WBC counts in predicting perforated appendicitis in children.Principal conclusionsRoutine urinalysis may serve to aid in discriminating between simple and perforated appendicitis. Clinically, we believe that these urine parameters may aid primary emergency physicians with decision making in patients with clinically suspected appendicitis.     

左氧氟沙星、甲硝唑联合薄芝糖肽防治化脓性阑尾炎术后感染

目的:观察用左氧氟沙星、甲硝唑联合薄芝糖肽预防及治疗化脓性阑尾炎手术后感染的效果。方法:将146例急性化脓性阑尾炎手术患者随机分成两组,A组79例采用左氧氟沙星、甲硝唑预防及治疗术后感染。B组67例采用左氧氟沙星、甲硝唑联合薄芝糖肽预防及治疗术后感染。结果:B组治愈63例(94.0%),改善3例(4.5%),失败1例(1.5%);A组治愈61例(77.2%),改善10例(12.7%),失败8例(10.1%)。两组总有效率比较差异有显著性(P=0.027)。结论:左氧氟沙星、甲硝唑联合薄芝糖肽预防及治疗急性化脓性阑尾炎术后感染有较好的效果。     

Diagnostic and prognostic significance of study of acute phase proteins in children with appendicular peritonitis

Acute phase proteins (fibrinogen, alpha 2-macroglobulin, alpha 1-antitrypsin) were measured in 47 patients with destructive appendicitis and 203 children with local (n = 121) and disseminated (n = 82) appendicular peritonitis. The patients' ages varied from 3 to 15 years. Control group consisted of 45 age-matched children with uncomplicated umbilical and inguinal hernias. The significance of acute phase proteins in the diagnosis and preoperative and postoperative treatment planning was evaluated.     

Does the Use of Ultrasonography Improve the Outcome of Children with Appendicitis?

Abstract. Objective: To determine whether the use of ultrasonography (US) improves the outcome of children with appendicitis.
Methods: All cases of patients (< 17 years old) with pathologically confirmed appendicitis treated in the ED between July 1992 and December 1995 were retrospectively reviewed.
Results: 231 charts met criteria for analysis. 100 (43%) patients had US prior to surgery. Age, race, and insurance status were similar for children in the US and non-US groups; there were no differences between the groups at presentation in mean temperature, mean WBC count, or percentage of children with vomiting, diarrhea, abdominal tenderness, or guarding. Those in the non-US group were more often male (71%, p = 0.002) and more frequently had right lower quadrant pain (65%, p = 0.003). Time from ED triage to the OR was 17.1 hours (US group) vs 10.4 hours (non-US group) (p = 0.002). The perforation rates and the complication (abscess, wound infection, wound dehiscence) rates were similar for children in the two groups. Hospital charges were higher in the US group than in the non-US group ($14,123 vs $13,021, p = 0.007).
Conclusion: The use of US did not result in early diagnosis of appendicitis, nor was it associated with a reduction in perforation or complication rates. Among children with clinical evidence of appendicitis, US was associated with a delay in surgery and an increase in hospital charges.     

Sequential cytokine levels in the diagnosis of appendicitis

OBJECTIVE: To determine the diagnostic value of sequential white blood cell count (WBC), tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in patients with abdominal pain. MATERIAL AND METHODS: Tests were determined at hospital admission and 6 h later in 105 children. Patients who were non-operatively followed and had a normal histopathology were classified as the non-appendicitis (NA) group. Patients with symptoms consistent with appendicitis were classified as the appendicitis group (A). Data were analyzed as positive/negative predictive value, sensitivity, specificity and accuracy rate (AR). The global power of the variables in discriminating the patients between the two groups and advanced/simple appendicitis was assessed from the area under the receiver operating characteristic (ROC). RESULTS: Initial measurements showed WBC to be a valuable diagnostic tool in acute appendicitis (AR = 74 %), whereas IL-6 and TNF-alpha were found not to be valuable. The second measurements revealed higher values, and IL-6 reached its highest AR (89 %). When initial values were evaluated in combination, the highest AR of 73 % was observed with TNF-alpha + WBC. The highest AR (90 %) was seen with IL-6 + TNF-alpha in the second measurements. ROC analysis showed WBC to be the most valuable parameter of the three. The area under the curve (AUC) was 0.750 for the initial measurement and 0.779 for the repeat measurement of WBC (p = 0.001). The most useful diagnostic parameter in discriminating between the simple and the advanced cases was IL-6 as assessed with the ROC curve (p<0.01). CONCLUSIONS: WBC elevation in patients with suspected acute appendicitis is an important parameter supporting the diagnosis at initial admission, whereas IL-6 is a more valuable tool in diagnosing advanced appendicitis.