经脐单孔腹腔镜阑尾切除术82例临床报告

目的探讨经脐单孔腹腔镜阑尾切除术的临床价值。方法我院2009年8月～2010年5月对82例阑尾炎,在脐孔切口1.5 cm应用10 mm 30°腹腔镜,另外置入1～2枚5 mm trocar完成腹腔镜下阑尾切除手术。结果 82例手术均获成功,无中转开放手术及改变手术方式。32例经脐单孔双trocar法手术时间25～50 min,平均34 min。住院时间2～5d,平均3.3 d。50例经脐单孔三trocar法手术时间20～45 min,平均27 min。住院时间2～5 d,平均2.8 d。80例术后随访5～14个月,无切口感染、再发右下腹痛等发生。结论经脐单孔腹腔镜阑尾切除术简单易行、安全、并发症少、恢复快、美容效果较好,但需要特殊的可弯曲腹腔镜操作器械,手术费用较高。     

经脐单孔腹腔镜阑尾切除术112例报告

目的:探讨经脐单孔腹腔镜阑尾切除术(laparoscopic appendectomy,LA)的操作要点及手术方法。方法:回顾分析2012年11月至2013年7月为112例患者行经脐单孔LA的临床资料。结果:3例因阑尾周围脓肿、7例因阑尾根部坏疽穿孔中转为常规三孔法腹腔镜手术,1例因阑尾萎缩位于浆膜内中转开腹,余101例手术获得成功。手术时间平均(20.0±3.6)min,术中出血量均小于5 ml,术后平均(6.5±0.8)h下床活动,平均(8.0±2.6)h排气,平均住院(3.4±1.5)d。患者均恢复良好,无出血、粪漏、切口感染、切口疝、残株炎、粘连性肠梗阻等并发症发生,患者对术后疼痛、恢复情况、皮肤美容效果均满意。结论:经脐单孔LA操作方便,手术安全、可行,具有疗效确切、美容效果佳、疗效好、术后康复快、学习曲线短、住院费用低等优点,适于基层医院推广应用。     

经脐单孔腹腔镜阑尾切除术12例报告

<正>2010年7月至2011年3月我院为12例患者施行经脐单孔腹腔镜阑尾切除术,效果满意。现报道如下。1资料与方法1.1临床资料本组12例患者16～46岁,平均32岁。其中慢性阑尾炎7例,急性单纯性阑尾炎4例,急性化脓性阑     

经脐单孔腹腔镜阑尾切除术51例报告

目的:探讨基层医院行经脐单孔腹腔镜阑尾切除术的可行性,并总结手术经验.方法:回顾分析51例经脐单孔腹腔镜阑尾切除术的手术经验及临床资料.结果:48例成功施行经脐单孔腹腔镜阑尾切除术,手术时间30～90 min,术后无出血、粪漏等并发症发生,恢复良好,治疗及美容效果满意.1例因阑尾根部坏疽穿孔中转开腹,2例因放置引流管增...     

经脐单孔腹腔镜阑尾切除术92例临床分析

目的:探讨经脐单孔腹腔镜阑尾切除术(laparoscopic appendectomy,LA)治疗阑尾炎的疗效及手术价值。方法:回顾分析2013年5月至2015年4月92例经脐单孔LA患者的临床资料。术中使用常规腹腔镜器械完成手术,无特殊器械。结果:92例患者中83例成功施行单孔LA,成功率90.2%。术中出血量10～34 ml,平均(15.26±5.36)ml;术后排气时间8～28 h,平均(14.12±2.46)h;住院2～7 d,平均(3.0±1.81)d,92例均治愈出院。术后病理证实急性单纯性阑尾炎47例、慢性阑尾炎16例、化脓性阑尾炎20例、坏疽性阑尾炎9例。83例随访3～12个月,均无严重并发症发生。结论:经脐单孔LA对器械要求不高,可在基层医院开展,并以腹部切口少、美观、术后康复快等特点逐渐被患者尤其年轻女性患者所接受,能较好地避免开腹手术切口感染、不愈合等并发症。     

经脐单一部位腹腔镜阑尾切除术26例报告

目的探讨经脐单一部位腹腔镜阑尾切除术（transumbilical single-incision laparoscopic appendectomy,TUSILA）的安全性和可行性。方法 2011年1～10月我院行28例TUSILA。在脐下缘做一15～20 mm弧形切口,置入2个10 mmtrocar和1个5 mm trocar,置入10 mm 30°电子腹腔镜和腹腔镜器械,完成阑尾切除术。结果 26例成功施行TUSILA,1例盲肠后位阑尾炎中转开腹,1例改三孔法腹腔镜阑尾切除术。26例TUSILA手术时间25～60 min,（40.6±12.8）min;术后24h下床活动,恢复流质饮食;术后2～5 d出院。26例随访1～6个月,平均4.6月,均无术后出血、肠漏、切口感染等并发症,切口瘢痕隐蔽,患者对美容效果满意。结论 TUSILA安全可行,美容效果突出,与传统腹腔镜阑尾切除术相比,操作难度增加,术者须严格掌握手术适应证,操作困难时应及时转为常规腹腔镜或中转开腹手术。     

悬吊辅助法经脐单孔腹腔镜阑尾切除术

目的：评价悬吊辅助法经脐单孔腹腔镜阑尾切除术（transumbilical single-port laparoscopic appendectomy,TUS-PLA）的可操作性、安全性、微创性及美容效果。方法：2007年3月至2009年10月为39例成年慢性阑尾炎患者行腹腔镜阑尾切除术（laparoscopic appendectomy,LA）。在难以完成拖出法TUSPLA时,利用Endoclose经腹壁悬吊配合带操作通道的同轴腹腔镜完成全腹腔内操作的TUSPLA。结果：8例（21%）行拖出法TUSPLA,手术时间平均18.5min;26例（67%）行悬吊辅助法TUSPLA,手术时间平均41min;5例（13%）行两孔法LA,手术时间平均52min。所有患者均于术后2~3d出院。无术后并发症发生,脐部疤痕不明显。结论：利用Endoclose经腹壁吊线辅助,多数LA可经单个1cm的脐部切口完成。其操作简便、安全,能获得更好的微创和美容效果。     

经脐单孔腹腔镜阑尾切除术11例

我院自2010年6月至2011年6月选择11例阑尾炎病人采用经脐单孔腹腔镜技术行阑尾切除术,现报告如下。     

经脐单孔腹腔镜阑尾切除术治疗老年急性阑尾炎患者的效果分析

目的 探讨经脐单孔腹腔镜阑尾切除术(LA)治疗老年急性阑尾炎患者的安全性和效果。方法 回顾性分析2021-01—2021-11浚县人民医院行LA治疗的79例老年急性阑尾炎患者的临床资料。分为经脐单孔组(单孔组,37例)和常规三孔组(三孔组,42例)。比较2组患者的术中情况、术后临床指标。以数字评分法(NRS)评分评价患者术后6 h、24 h、48 h的疼痛程度。统计术后并发症发生率和患者的满意度。结果 2组手术时间、术中出血量和术后并发症发生率的差异均无统计学意义(P>0.05)。单孔组患者术后下地活动时间、肠鸣音恢复时间、肛门排气时间、恢复进食时间,以及住院时间均短于三孔组;术后6 h、24 h、48 h的NRS评分均低于三孔组,患者的满意度高于三孔组。差异均有统计学意义(P<0.05)。结论 经脐单孔LA的手术时间、术中出血量和术后并发症发生率与常规三孔LA的差异无统计学意义。但经脐单孔LA有利于促进老年急性阑尾炎患者术后胃肠功能恢复、减轻疼痛程度和提升患者的满意度。     

腹腔镜小儿阑尾切除术52例报告

目的探讨腹腔镜在小儿阑尾切除术中的应用价值. 方法 2002年10月～2004年12月应用腹腔镜三孔法行小儿阑尾切除术52例. 结果 52例均顺利完成手术,手术时间20～50 min,平均30 min.术后2～4 d出院.2例穿刺孔周围发生皮下气肿,无其它并发症.49例随访3～29个月,平均14个月,无肠梗阻、腹腔内残余感染等发生. 结论腹腔镜小儿阑尾切除术创伤小,并发症少,安全,疗效确切.     

Transumbilical extracorporeal laparoscopic-assisted appendectomy

Aim of the study

The perfect balance between safety, cosmesis, and cost effectiveness in a world with ever growing healthcare costs has yet to be found for nonperforated appendicitis. The aim is to present our data regarding safety and cost effectiveness of the transumbilical extracorporeal laparoscopic-assisted appendectomy technique.

Needlescopic appendectomy

Background: In this paper, we compare our experience with the techniques of needlescopic appendectomy (NA) (2-mm instruments) for the treatment of acute appendicitis with the more conventional approach of a laparoscopic appendectomy (LA). Methods: We did a retrospective review of patients who underwent NA for the diagnosis of acute appendicitis between August 1996 and January 2002. Variables including operative time, blood loss, postoperative time to discharge, intra- and postoperative complications were analyzed and compared to data from control patients who had undergone an LA for acute appendicitis. Results: The NA group had a longer average operating time (54.5 ± l3 vs. 42.5 ± 12.6 min, p = 0.0001) and a longer postoperative hospital stay (2.1 ± 1.4 vs. 1.3 ± 1.1 days, p = 0.01). Blood loss was similar for the two groups. Conclusions: With the exception of superior cosmesis, NA appears to have little advantage over the better-established LA; moreover, it has some disadvantages. A clearer benefit of this procedure over LA, as well as improvements in instrumentation, needs to be shown before it can be widely accepted. Presented in poster format at the 8th World Congress of Endoscopic Surgery, NewYork, NY, USA, 13–16 March 2002     

Laparoscopic appendectomy in pregnancy

Summary Since 1982 we have operated on more than 150 patients using the laparoscopic appendectomy technique. Our complication rate was 0.75% and the patients included six pregnant women in all stages of pregnancy. There were no complications in this group of six women.Based on a presentation to the XII World Congress of Gynecology and Obstetrics, Rio de Janeiro 1988     

Day case emergency laparoscopic appendectomy

Background Laparoscopic appendectomy (LA) is associated with a shorter hospital stay and fewer complications than conventional open appendectomy (OA). This study aimed to examine the safety and efficacy of day case emergency LA. Methods The records of patients undergoing emergency LA under the care of two laparoscopic surgeons over a 3-year period (Februrary 2003 to February 2006) were reviewed to examine hospital length of stay (LOS), complications, histology, grade of the operating surgeon, and time required to perform the procedure. Results A total of 104 patients (median age, 25 years; range, 11–72 years; 58 men) underwent LA, with 9 and 66 patients discharged in 8 and 24 hours, respectively (median LOS 22 hours: range 6–170 hours). One patient underwent conversion to OA. Histologically, 86 patients had appendicitis and 18 had normal appendices with another pathology present. The median operative time was 35 min (range, 20–80 min). The complications included three wound infections and two pelvic abscesses not requiring further operative intervention. Conclusion Day case emergency LA is safe and effective for treating selected patients.     

Early experience with laparoscopic appendectomy in women

Summary Experience and the surgical technique of laparoscopic appendectomy in 70 female patients over a period of more than three years is described. Three women were pregnant. Complications occurred in one case.     

Postoperative bowel obstruction after laparoscopic and open appendectomy in children: a 15-year experience

Purpose

The purpose of the study was to determine and evaluate the incidence of postoperative bowel obstruction (PBO) after laparoscopic and open appendectomy in children.

Material and Methods

The medical files of children who have undergone an appendectomy, either via the laparoscopic or open approach, at our department from 1992 until 2007 were reviewed. Collected data included age at appendectomy, initial surgical approach, time interval to PBO, and type of definitive treatment. The incidences of PBO after laparoscopic and open appendectomy were compared with the χ² analysis.

Results

From the 1684 children who were found, 1371 had nonperforated appendicitis and 313 had perforated appendicitis. Laparoscopic appendectomy was performed in 954 patients of the nonperforated group and in 221 of the perforated group. Open appendectomy was performed in 417 and 92 patients of the 2 groups, respectively. Overall, the incidence of PBO development was 2.2%. In the laparoscopic appendectomy population, a significantly low incidence of 1.19% of PBO development was detected, compared with the 4.51% of the open appendectomy group (P < .0001).

Conclusion

Laparoscopic appendectomy diminishes the potential of PBO development. The overall incidence of PBO is not related to the severity of the disease but only to the initial operative approach.     

What is the learning curve for laparoscopic appendectomy?

When contemplating converting from open to laparoscopic appendectomy, a prudent surgeon should consider the anticipated learning curve. To evaluate this we reviewed our experience with 20 sequential patients representing this transition. We found the learning curve was brief and did not compromise clinical results. A reduction in hospitalization time without a rise in total hospital costs should encourage the experienced laparoscopic surgeon to consider laparoscopic appendectomy as a viable alternative to standard laparotomy in the resection of the acutely inflamed appendix.Presented at the Priestley Society Meeting, sponsored by the Mayo Clinic Surgical Society, Monterrey, CA, USA, 8–9 October 1993     

腹腔镜胆囊、阑尾联合切除术126例报告

目的探讨腹腔镜胆囊、阑尾联合切除适应证及可行性. 方法全麻下按LC常规切除胆囊,右麦氏点10 mm trocar内置入分离钳,夹阑尾远端于腹腔外切除,或钛夹夹闭阑尾系膜及根部,电刀切除阑尾. 结果手术时间29～76 min,平均48 min.术后住院2～7 d,平均3 d.并发症3例,胆总管横断伤1例,阑尾动脉出血1例,右下腹不明原因疼痛1例. 结论胆囊良性病变合并单纯性、化脓性阑尾炎为腹腔镜胆囊、阑尾联合切除的适应证,技术可行.