腹腔镜下钛夹法治疗阑尾炎(附213例病例报告)

目的探讨腹腔镜下钛夹法治疗阑尾炎的疗效。方法回顾性统计4年来腹腔镜下应用钛夹法治疗阑尾炎213例临床资料,进行统计学分析并讨论。结果全组平均住院天数(6.5±4.0)d,平均住院费用(5240±2250)元,分别低于和高于传统开腹手术(P<0.01和P<0.001),但在术后并发症上没有统计学差异。结论腹腔镜下应用钛夹法切除阑尾安全、有效,伤口美观,恢复快,但费用较高,可根据病人经济条件和心理需求选择应用。     

腹腔镜下阑尾切除术临床价值分析

目的:探讨腹腔镜阑尾切除术的临床价值及可行性。方法:随机对63例腹腔镜阑尾切除术和同期50例开腹阑尾切除术进行比较。结果:在各类阑尾炎中,腹腔镜阑尾切除术在胃肠功能恢复、住院时间均较开腹阑尾切除术短;在切口感染、术后疼痛方面、观察腹腔其他疾病方面,较开腹手术具有明显优越性;而手术时间并不比开腹手术长,但费用稍高。结论:腹腔镜阑尾切除术具有明确诊断、创伤小、痛苦少、住院时间短及切口感染率低等优点,可考虑成为阑尾切除的首选手术方式。     

改良三孔法腹腔镜阑尾切除术与传统阑尾切除术的比较

目的:比较改良三孔法腹腔镜阑尾切除术(LA)和开腹阑尾切除术(OA)的优缺点.方法:回顾性分析我院普通外科2011年1月至2011年8月收治的手术治疗急性阑尾炎66例的临床资料,其中36人行LA,30人行OA.结果:LA组及OA组的手术时间分别为(25.7±3.8)min及(45.3±6.4)min,住院时间分别为(3.1±1.5)d及(7.5±3.4)d.住院费用分别为(10350.9±1060.4)元及(6534.8±745.6)元,各指标比较均有统计学差异(P<0.05).结论:改良三孔法腹腔镜阑尾切除术较开腹阑尾切除术在治疗费用上虽不具优势,但在阑尾炎诊治的全面性、手术时间、术后恢复、伤口感染率及伤口美观性等方面具有明显优势,值得推广.     

Abdominal pain secondary to stump appendicitis in a child

We report a case of an 11-year-old male who presented with abdominal pain and vomiting. The patient had a notable past medical history of having had an appendectomy at our institution 1 year previously. Because of progressive clinical signs of peritonitis, an exploratory laparotomy was performed and the patient was found to have stump appendicitis. The entity of stump appendicitis is always possible when evaluating patients with abdominal pain who have a history of appendectomy.     

腹腔镜阑尾切除术与传统阑尾切除术比较

目的比较腹腔镜阑尾切除术（laparoscopic appendectomy,LA）与传统剖腹阑尾切除术（open appendectomy．OA）的临床效果。方法回顾性分析LA组46例与同期OA组46例,比较两组平均住院费用、住院时间、切口长度、术后镇痛剂应用、术后6h开始下床活动与术后24h内肛门排气例数等临床资料。结果LA组的平均住院费、平均住院时间、切口长度与OA组比较,差异均有统计学意义（t分别=45．75、23．63和13．73,P均〈0．05）。LA组的术后镇痛剂应用例数、术后6h开始下床活动例数与术后24h内肛门排气例数与OA组比较,差异均有统计学意义（Χ^2分别=62．90、39．81和6．13,P均〈0．05）。结论LA与OA比较,有手术损伤小、疼痛轻、恢复快、住院时间短等优点,而平均住院费较高。     

腹腔镜阑尾切除术中的常见困难与处理

目的探讨腹腔镜阑尾切除术（hparoscopic appendectomy，LA）的常见困难和处理办法。方法回顾性分析近3年来该院普外科采用腹腔镜治疗的112例阑尾炎患者的临床资料。结果109例在腹腔镜下顺利完成手术，其余3例中转开腹，阑尾显露困难14例，阑尾周围重度粘连7例，系膜出血5例，阑尾根部坏死6例。手术时间30～125min，住院时间3～8d，3例戳孔感染经对症治疗痊愈，无术后出血、肠粘连等并发症发生。结论LA治疗阑尾炎安全可行，符合微创观点，熟练的腹腔镜技术是保证手术成功、减少并发症的关键。     

Single-port laparoscopic appendectomy using a needle-type grasping forceps compared with conventional three-port laparoscopic appendectomy for patients with acute uncomplicated appendicitis: a single-center retrospective study

ObjectiveTo compare the clinical outcomes between single-port laparoscopic appendectomy using a needle-type grasping forceps (SLAN) and conventional three-port laparoscopic appendectomy (CLA) for patients with uncomplicated appendicitis.MethodsWe retrospectively collected clinical data of patients with uncomplicated appendicitis who underwent SLAN or CLA from May 2019 to May 2021 in our center. The patients’ baseline characteristics, perioperative outcomes, and follow-up data were compared between the two groups. Additionally, baseline characteristics were compared with postoperative outcomes in the SLAN group.ResultsNinety-six patients were enrolled (SLAN group, n = 32; CLA group, n = 64). The SLAN group had a shorter hospital stay, lower 24-hour postoperative visual analogue scale scores, shorter postoperative fasting time, lower frequency of antibiotic administration, and longer operative time than the CLA group. In the SLAN group, younger patients had a longer appendix and male patients had a thicker appendix; additionally, patients with an appendiceal diameter of 0.6 to 1.0 cm had a longer postoperative hospital stay and higher frequency of antibiotic administration.ConclusionsCompared with CLA, SLAN may be less invasive, provide faster postoperative recovery, and result in better cosmesis for patients with uncomplicated appendicitis. Further research should be performed to evaluate the long-term outcomes.     

腹腔镜阑尾切除术临床价值再探讨

目的：观察和探讨腹腔镜阑尾切除术临床价值。方法选取本院普外科病房2014年8月至2015年7月期间收治的阑尾切除术患者76例,根据手术方式的不同将上述病例分为两组,观察组患者46例行三孔腹腔镜阑尾切除术,对照组患者30例行开腹阑尾切除术。观察并比较两组患者手术过程中和术后恢复相关临床指标。结果经治疗观察组手术时间、手术切口长度、术中出血量、术后首次排气时间、进食时间、术后止痛药物使用率、住院时间、并发症发生率均显著优于对照组,差异有统计学意义（P＜0．05）。结论腹腔镜阑尾切除术与传统开腹阑尾切除术相比具有损伤轻、恢复快、并发症少的特点,值得临床推广。     

Spontaneous unilateral dizygotic twin tubal pregnancy

Spontaneous dizygotic unilateral twin tubal pregnancy is an extremely rare occurrence with a high risk for pregnancy-related mortality, and a diagnostic challenge for obstetricians. We present a case of a 27-year-old woman with spontaneous twin tubal pregnancy. Transvaginal color Doppler sonography revealed 2 separate gestational sacs within the right adnexa, each containing an embryo. Cytogenetic examination of the trophoblastic tissues confirmed the diagnosis of dizygotic twin ectopic pregnancy. Clinical signs and symptoms together with imaging studies help in the diagnosis of this rare variant of ectopic pregnancies.     

腹腔镜阑尾切除术治疗特殊类型的阑尾炎的技术分析和研究

目的总结腹腔镜阑尾切除术在特殊类型阑尾炎中的治疗体会。方法3年来该院共有78例特殊类型的阑尾炎患者采取LA，并且随机选择同期95例特殊类型阑尾炎非腹腔镜阑尾切除术作对照，对其手术适应证、手术方法、术后的恢复情况、术后疼痛和并发症及住院时间和费用等进行了回顾性分析。结果78例术后均经病理证实为阑尾炎，5例患者术中探查发现并存有其他疾病并且同时应用腹腔镜治愈，3例术前没有完全确诊，术中经腹腔镜探查确诊，1例因为腹腔广泛粘连而转为开腹。术后患者疼痛感轻微，无切口感染及院内感染，平均住院4．5d，住院费用与同期同类手术的差别无统计学意义。结论LA对于特殊类型的阑尾炎是一种较为理想的手术方式，具有损伤小，恢复快，可避免误、漏诊的优点。     

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。     

Interstitial twin pregnancy: A unique case presentation

Early recognition and timely treatment of an interstitial pregnancy is imperative to avoid the high morbidity and mortality of this type of ectopic pregnancy. We report a case of twin interstitial pregnancy that was initially missed on initial sonogram and was subsequently recognized at our institution by transvaginal sonography. The patient underwent open laparoscopic surgery with cornual wedge resection but suffered infundibulopelvic ligament hemorrhage and subsequently required ipsilateral salpingo‐oophorectomy. She did well and was discharged home a day later. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43 :447–450, 2015     

腹腔镜阑尾切除术与传统开腹阑尾切除术的临床对比研究

目的：比较腹腔镜阑尾切除术和开腹阑尾切除术的临床效果。方法：将138例阑尾炎患者按意愿分为接受腹腔镜阑尾切除术（LA组）和开腹阑尾切除术（OA组）,比较两组的手术时间、术后疼痛、下床时间、肛门排气时间及其他并发症的发生率。结果：与OA组相比,LA组手术时间明显延长（P〈0.01）、术后疼痛程度较轻（P〈0.05）、术后下床时间缩短（P〈0.01）;但两组术后肛门排气时间、切口感染发生率比较差异无统计学意义（P〉0.05）。结论：LA是一项微创、安全的手术,具有术后下床早、并发症少等优点。     

Primary twin ovarian pregnancy: case report and review of the literature

Primary twin ovarian pregnancy is extremely rare. We present one such case in a 25-year-old primigravida who complained of lower abdominal pain and mild vaginal bleeding at 8 weeks after her last menstrual period. Transvaginal sonography revealed an empty uterus and presence of a gestational sac containing 2 dead embryos in the right ovary. The patient underwent unilateral oophorectomy, and histologic studies confirmed a uniovular-diamniotic ovarian pregnancy. A brief review of the literature revealed that primary ovarian pregnancy may occur without any classical antecedent risk factors, and endovaginal sonography can be useful to establish early preoperative diagnosis of ectopic ovarian pregnancy.     

三孔法腹腔镜阑尾切除术不同Trocar入路的对比研究

目的比较腹腔镜阑尾切除术中常规Trocar入路与改良Trocar入路的优缺点。方法不同性质阑尾炎患者采用不同Trocar入路行腹腔镜阑尾切除术,对患者的手术时间进行比较。结果腹腔镜阑尾切除术采用改良Trocar入路与常规Trocar入路手术时间比较,差异有显著性(P﹤0.05)。结论改良Trocar入路能节约手术时间,降低手术风险,在腹腔镜阑尾切除术具有推广应用的价值,用超声刀行腹腔镜阑尾切除术治疗效果良好。     

腔镜阑尾切除切口设计及选择(120例临床分析)

目的 探讨腹腔镜阑尾切除时切口设计及选择的若干问题.方法 回顾性分析2006年6月～2008年6月在该院明确诊断为阑尾炎而行腹腔镜阑尾切除术的120例患者的手术前情况手术时切口及入路的设计及选择、术后并发症等临床资料.结果 全部患者均成功实施了腹腔镜阑尾切除,无中转开腹手术,手术时间30～120min,平均65.2min,住院时间2～9 d,平均3.5 d,117例患者无术后并发症,2例患者术后出现腹腔脓肿,1例经穿刺引流治愈,1例术后经抗感染治疗,脓肿吸收.1例患者出现术后肠瘘,经持续低压冲洗引流后治愈.结论 遵循个体化原则,采取正确的腹部切口设计及入路选择是手术成功的关键.     

腹腔镜治疗小儿急性阑尾炎36例

目的探讨腹腔镜在小儿阑尾切除术中的应用价值。方法回顾性分析2005年9月至2006年12月应用腹腔镜三孔法行小儿阑尾切除术36例的临床资料。结果36例均顺利完成手术,手术时间30~90 min,平均50 min。术后3~5 d出院。术后并发穿刺孔周围发生皮下气肿1例,并发腹腔内脓肿1例。28例随访3~15个月,平均9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。     

Laparoscopic appendectomies: Experience of a surgical unit

Appendicitis is one of the most common causes of acute abdomen in adults and appendectomy is the most common emergency abdominal procedure. Laparoscopic appendectomy has gained popularity only in recent years and the optimal approach for the treatment of acute appendicitis is still under debate. This retrospective study aimed at examining the current indications for laparoscopic appendectomy. 1024 patients undergoing laparoscopic appendectomy between February 1992 and December 2007 were retrospectively reviewed. 39.9% of patients (n=408) underwent emergency surgery. In 616 cases (60.1%) conservative management was performed in vain and these patients underwent an elective operation. In the 36 patients with an intraoperative normal appendix, other pathological findings were laparoscopically detected and treated. Conversion to an open procedure was required for 13 (1.3%) cases. The mean operative time was 38 min and the average length of postoperative hospitalization was 2.5 days. The overall morbidity rate was 2.6%. Laparoscopic appendectomy should be considered a procedure of choice for the treatment of non-complicated appendicitis. We stress the possibility to laparoscopically treat even complicated appendicitis in the surgical setting with substantial experience in minimally invasive surgery.