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。     

单孔悬吊法腹腔镜阑尾切除术的应用体会

目的：探讨单孔悬吊法腹腔镜阑尾切除术（laparoscopic appendectomy,LA）的可行性,并总结治疗体会。方法：为43例阑尾炎患者施行单孔悬吊法LA。经脐部单孔分别置入腹腔镜和操作钳,找到阑尾后,从右下腹置入细铜丝悬吊起阑尾根部,在腹腔内完成阑尾切除,经脐孔拖出阑尾。结果：手术时间25-97min,平均36min,1例中转开腹,1例经两孔法切除。术后1例发生脐孔感染,无其他并发症发生。所有患者均痊愈出院。平均住院4.5d。结论：单孔悬吊法LA操作简单、有效、可行,扩大了单孔LA的适应证,并且有很好的美容效果。     

悬吊固定法在腹腔镜阑尾切除术中的应用

目的:探讨腹腔镜阑尾切除术(LA)的简易方法。方法:应用悬吊固定法,行三孔法腹腔镜阑尾切除术53例。以2mm细铁丝或带线皮针自腹壁刺入腹腔内,用细铁丝或缝线固定阑尾头部及根部,收紧腹壁外细铁丝或缝线,使阑尾游离端相对固定,然后行阑尾切除术。结果:手术均获成功,无中转开腹,平均手术时间20m in,比常规LA缩短10~15m in,平均住院3d。结论:悬吊固定法LA较非固定LA具有简单易行,手术时间短,安全快捷,避免腹腔内金属异物存留等优点。     

改良两孔悬吊法腹腔镜小儿阑尾切除术62例报告

目的:探讨改良两孔悬吊法腹腔镜阑尾切除术治疗小儿急性阑尾炎的可行性、优点及注意事项。方法:回顾分析2011年6月至2012年5月采用改良两孔悬吊法腹腔镜阑尾切除术治疗62例小儿急性阑尾炎患者的临床资料。结果:62例均顺利完成改良两孔悬吊法腹腔镜阑尾切除术,手术时间平均(48±13)min,术后12~23 h恢复通气。4例患儿术后2~3 d右上腹切口感染,经换药、微波理疗1周后愈合。术后均无粪瘘,腹、盆腔脓肿及粘连性肠梗阻等其他并发症发生,术后平均住院(4±1)d。随访1~2年,无粘连性肠梗阻等相关并发症发生。结论:改良两孔悬吊法腹腔镜阑尾切除术治疗小儿急性阑尾炎具有创伤小、康复快、住院时间短、并发症少、安全有效等优点,但应根据术中实际情况操作,切不可盲目追求微创。     

二孔法结合改良三孔法腹腔镜阑尾切除术562例报告

目的总结二孔法结合改良三孔法腹腔镜阑尾切除术(laparoscopicappendectomy,LA)的经验。方法2002年7月~2006年3月对慢性阑尾炎44例、急性阑尾炎518例行二孔法或改良三孔法LA术,其中二孔拖出法159例(28.3%),改良三孔法403例(71.7%)。结果全部病例均成功完成LA,平均手术时间(43±28)min,二孔法手术时间为(36±21)min,三孔法为(55±32)min。术中平均出血量15(2~50)ml。术后并发切口感染11例,炎性肠梗阻和腹腔内出血各1例。平均住院时间4.1(2~7)d。396例(70.5%)获随访,平均8(2~36)个月,无并发症发生。结论腹腔镜阑尾切除术是一种安全理想的手术方式。二孔法和三孔法LA各有其优缺点,术中应根据患者具体情况合理使用。     

悬吊辅助法腹腔镜阑尾切除术

目的:总结悬吊辅助法在腹腔镜阑尾切除术中的应用经验。方法:带线深静脉置管针于麦氏点穿刺入腹,以穿刺针腹腔内侧端及线夹角固定阑尾(包括系膜),绷紧穿刺针腹腔外"2"号尼龙线,小直钳固定,调整穿刺针将阑尾固定在合适位置,以便手术操作。超声刀切断阑尾系膜,至阑尾根部,用16 mm Hem-o-lok结扎处理阑尾根部,阑尾残端电刀烧灼。结果:50例成功施行悬吊辅助法腹腔镜阑尾切除术,2例因阑尾根部穿孔中转开腹。手术时间30~70 min,平均(41.0±7.4)min,不包括麻醉前后及准备器械时间;失血量5~10 ml,术后肛门排气时间4~26 h,平均(18.0±5.6)h。术后未使用止痛剂。术后病理示急性单纯性阑尾炎3例,急性化脓性阑尾炎47例,坏疽性阑尾炎2例。住院3~7 d,平均(4.0±0.8)d。术后2个月后复查,均无切口感染、切口疝、肠梗阻及右下腹疼痛等并发症发生。结论:悬吊辅助法腹腔镜阑尾切除术未明显增加手术时间与手术难度,除具有三孔腹腔镜阑尾切除术康复快、并发症少等优点外,美容效果更佳。     

改良腹腔镜阑尾切除术290例应用分析

目的总结归纳改良腹腔镜阑尾切除术(laparoscopic appendectomy,LA)的操作技巧。方法采用小操作孔三孔法操作、阑尾系膜单极电凝法、体外打结、推结器推结结扎阑尾根部、自制标本袋取出阑尾等改良的LA技术操作,行改良LA 290例。结果 290例均成功完成手术,无一例中转开腹。手术时间30~60 min,平均45 min。290例术后随访3~24个月,平均6个月,无出血、残端瘘、肠梗阻等并发症。结论改良腹腔镜阑尾切除术操作简单,安全可靠,治疗费用更低。     

应用传统器械行改良单孔腹腔镜阑尾切除术52例体会

目的探讨应用传统器械经脐行改良单孔腹腔镜阑尾切除术的临床价值。方法回顾性分析笔者所在医院2010年1月至2012年2月期间行经脐单孔腹腔镜阑尾切除术的52例阑尾炎患者的临床资料,总结手术经验。结果 52例患者均顺利完成手术,平均手术时间为39.2 min（18～70 min）,术后平均住院时间为5 d（3～12 d）。其中,45例患者成功完成经脐单孔腹腔镜阑尾切除术,2例中转开腹,2例行两孔LA术,3例行三孔LA术。术后2例患者发生切口感染。29例患者获访,随访时间4～18个月,平均12个月,无出血、切口疝、腹腔残余感染、粘连性肠梗阻、阑尾残端瘘等并发症发生。结论应用传统器械经脐行改良单孔腹腔镜阑尾切除术简单、安全、可行、患者恢复快、并发症少、美容效果较好,但操作难度相对更高。应严格掌握手术适应证,必要时及时增加戳孔或中转开腹。     

穿孔性阑尾炎的腹腔镜手术技巧

目的探讨穿孔性阑尾炎行腹腔镜阑尾切除术的技巧。方法2000年10月-2005年12月对112例穿孔性阑尾炎患者实施腹腔镜阑尾切除术(LA),对其临床资料进行分析。结果手术全部成功,无中转开腹,穿孔性阑尾炎术后均经病理证实,平均手术时间71.2min,术后排气时间21.6h,21例术后使用止痛药,16例置管引流,1例出现戳孔感染,无残余脓肿发生,平均住院时间5.2天。结论腹腔镜阑尾切除术在治疗穿孔性阑尾炎中具有创伤小、恢复快、并发症少和住院时间短等优点,熟练的手术技巧是手术成功的保证。     

腹腔镜阑尾切除术应注意的几个问题(附132例报告)

目的总结腹腔镜阑尾切除术（laparoscopic appendectomy,LA）治疗阑尾炎的经验。方法回顾性分析1999年8月至2006年8月我院行LA治疗的132例阑尾炎患者的临床资料,其中慢性阑尾炎急性发作19例,急性单纯性阑尾炎15例,急性化脓性阑尾炎93例,阑尾穿孔腹膜炎5例。结果2例中转开腹。130例成功完成LA,手术时间22～55min,平均30.5min;术中出血量2～10ml;住院2～12d,平均3.4d。术后出现早期炎性肠梗阻1例,经非手术治疗治愈。结论LA操作简便可行,操作得当可在基层医院推广。     

多功能阑尾悬吊器辅助两孔法腹腔镜阑尾切除术

目的:探讨多功能阑尾悬吊器辅助两孔法腹腔镜阑尾切除术的可行性、疗效及临床价值。方法:回顾分析2005年1月至2008年5月为49例患者行多功能阑尾悬吊器辅助两孔法腹腔镜阑尾切除术的临床资料。结果:49例手术均获成功,无中转开放手术,手术时间19～120min,平均27min,术后顺利康复,仅在脐缘及耻骨上方阴毛区留下2个小且隐蔽的切口瘢痕,随访24～60个月,平均33个月,无切口感染、肠粘连、大网膜粘连、切口疝等并发症发生,患者均对手术及美容效果感到满意,满意率达100%。结论:多功能阑尾悬吊器辅助两孔法腹腔镜阑尾切除术具有戳孔少、术后瘢痕小且隐蔽、戳孔感染率低、美容效果好等优点,是腹腔镜阑尾切除术的另一选择。     

Single-incision laparoscopic appendectomy: an early experience

Acute appendicitis is one of the most common causes of abdominal pain that a general surgeon will encounter. We describe our modification to the laparoscopic appendectomy: a single-incision laparoscopic (SILS) appendectomy completed entirely intracorporeally. From September 2008 to September 2009, a retrospective review of the electronic medical record was performed in all patients who underwent a SILS appendectomy to specifically analyze the demographic characteristics, time in the operating room to perform SILS appendectomy, length of postoperative hospital stay, and postoperative complications. Twenty-five patients underwent SILS appendectomy in the study period. There were 18 males and seven females with a mean age of 41 ± 15 years and mean body mass index of 26.5 ± 5 kg/m2. Single-incision laparoscopic appendectomy was performed successfully in all of our cases (100%). Mean operative time was 56 ± 16 minutes. Blood loss in all cases was minimal and there were no intraoperative complications. We successfully completed 25 appendectomies using the SILS method. Operative times were similar compared with the traditional laparoscopic technique. We believe that the SILS appendectomy is a safe and effective method that leaves a virtually invisible scar.     

腹腔镜胆囊切除联合阑尾切除术30例临床经验与分析

目的 探讨急、慢诊施行腹腔镜胆囊(Laparoscopic cholecystectomy,LC)联合阑尾切除术(Laparoscopic appendectomy,LA)的操作要点和临床价值.方法 回顾性分析了我院2006年9月至2010年2月对30例患者施行腹腔镜胆囊联合阑尾切除术.其中,急性胆囊炎合并慢性阑尾炎1...     

单孔腹腔镜阑尾切除术69例临床体会

目的:探讨总结丝线悬吊法单孔腹腔镜阑尾切除术的临床经验。方法:经脐部单孔置入腹腔镜和操作钳,右下腹刺入带线的圆针,缝合悬吊阑尾后结扎阑尾系膜和根部。结果:69例手术均获成功,平均手术时间36min,2~3d出院,无并发症发生。结论:丝线悬吊结扎法单孔阑尾切除术创伤小,无腹壁瘢痕,方法简单、可靠、价廉,易于推广。     

急诊腹腔镜阑尾切除术22例分析

目的:探讨急诊腹腔镜阑尾切除术(laparoscopic appendectomy,LA)的临床效果。方法:回顾分析2008年6月至2009年9月我院为22例患者行急诊LA的临床资料。结果:本组21例成功完成腹腔镜手术,1例中转开腹。手术时间35~72min,平均43min。术中出血8~20ml,无一例切口感染,平均住院4.5d。结论:LA具有患者创伤小,出血少,康复快,并发症少等优点,是安全、有效的阑尾切除术式。     

Can we afford to do laparoscopic appendectomy in an academic hospital?

BACKGROUND: Multiple studies have shown laparoscopic appendectomy to be safe for both acute and perforated appendicitis, but there have been conflicting reports as to whether it is superior from a cost perspective. Our academic surgical group, who perform all operative cases with resident physicians, has been challenged to reduce expenses in this era of cost containment. We recognize resident training is an expensive commodity that is poorly reimbursed, and hypothesized laparoscopic appendectomy was too expensive to justify resident teaching of this procedure. The purpose of this study was to determine if laparoscopic appendectomy is more expensive than open appendectomy. METHODS: From April 2003 to April 2004, all patients undergoing appendectomy for presumed acute appendicitis at our university-affiliated teaching hospital were reviewed; demographic data, equipment charge, minutes in the operating room (OR), hospital length of stay, and total hospital charge were analyzed. OR minute charges were gradated based on equipment use and level of skilled nursing care. Conversions to open appendectomy were included in the laparoscopic group for analysis. RESULTS: During the study period, 247 patients underwent appendectomy for preoperative diagnosis of acute appendicitis, with 152 open (113 inflamed, 37 perforated, 2 normal), 88 laparoscopic (69 inflamed, 12 perforated, 7 normal), and 7 converted (2 inflamed, 4 perforated, 1 normal) operations performed. The majority were men (67%) with a mean age of 31.4 +/- 2.2 years. Overall, there was significant difference (P < .05) in intraoperative equipment charge (125.32 dollars +/- 3.99 dollars open versus 1,078.70 dollars +/- 24.06 dollars lap), operative time charge (3,022.16 dollars +/- 57.51 dollars versus 4,065.24 dollars +/- 122.64 dollars), and total hospital charge (12,310 dollars +/- 772 dollars versus 16,773 dollars +/- 1,319 dollars) but no significant difference in operative minutes (56.3 +/- 1.3 versus 57.4 +/- 2.3), operating room minutes (90.5 +/- 1.7 versus 95.7 +/- 2.5), or hospital days (2.6 versus 2.2). In subgroup analysis of patients with uncomplicated appendicitis, open and laparoscopic groups had equivalent hospital days (1.47 versus 1.49) but significantly different hospital charges (9,632.44 dollars versus 14,251.07 dollars). CONCLUSIONS: Although operative time was similar between the 2 groups, operative and total hospital charges were significantly higher in the laparoscopic group. Unless patient factors warrant a laparoscopic approach (questionable diagnosis, obesity), we submit open appendectomy remains the most cost-effective procedure in a teaching environment.     

Laparoscopic appendectomy in patients with a body mass index of 25 or greater: results of a double blind, prospective, randomized trial.

BACKGROUND: The reported advantages of the laparoscopic approach to appendectomy are shortened hospital stay, less postoperative pain, and earlier return to usual activities (work). However, a prospective, randomized, double-blind trial comparing laparoscopic appendectomy with open appendectomy in active-duty males failed to disclose a benefit of laparoscopic appendectomy with regards to postoperative pain and return to work. The aim of our study was to compare open and laparoscopic appendectomy in overweight patients. METHODS: We conducted a prospective, randomized, double-blind study to determine whether laparoscopic appendectomy or the open procedure in overweight patients offers a significant reduction in lost workdays, postoperative pain, or operative time from. Open appendectomy in overweight patients (those with a body mass index > or =25) may be more difficult due to excessive subcutaneous adipose tissue. The open incision may be of considerable size, which may result in increased postoperative pain and a prolonged convalescence. RESULTS: There was a statistically significant increase in operative time for laparoscopic appendectomy of 11 minutes. As expected, the aggregate incision length for open appendectomy was twice that of the laparoscopic appendectomy. CONCLUSION: The data from this prospective, randomized, double-blind study failed to demonstrate any significant reduction in lost workdays, postoperative pain, or operative time with laparoscopic appendectomy.     

Appendectomy in the pre- and postlaparoscopic eras

The role of laparoscopic appendectomy remains controversial since many authors have suggested that overall morbidity is primarily a function of the degree of appendicitis rather than the operative approach. We have reviewed our appendectomy experience to determine the advantages and/or disadvantages of the laparoscopic technique in cases of acute appendicitis, and furthermore to ascertain whether the extent of disease should affect the surgical approach used. Data were accumulated for all 1158 patients who underwent appendectomy at a single institution during the following three time periods that span the pre- and postlaparoscopic eras: period I (1987 to 1990), period II (1991 to 1993), and period III (1994 to 1997). Cases were categorized with regard to pathologic findings and operative approach (i.e., open or laparoscopic appendectomy). The percentage of appendectomies performed laparoscopically increased with time (0%, 27%, and 79% for periods I, II, and III, respectively). Overall, the total operating room time was slightly shorter for laparoscopic compared to open appendectomy (99 vs. 102 minutes; P <0.05). Operating room times for open appendectomy remained unchanged, but the times for laparoscopic appendectomy decreased from period II to period III (119 to 94 minutes; P <0.001). In cases of gangrenous/perforated appendicitis, the times for laparoscopic appendectomy were significantly shorter than those for open appendectomy (98/115 vs. 120/125 minutes; P <0.001 for both). Overall, the hospital stay was shorter for patients undergoing laparoscopic appendectomy (1.63 vs. 4.21 days; P <0.001), and the difference was maintained in all three time periods. The differences in length of hospital stay for laparoscopic vs. open appendectomy were most dramatic in gangrenous/perforated cases (1.8/3.0 vs. 4.0/9.0 days; P <0.001), whereas there was only a slight difference in cases of simple appendicitis, for example, 1.6 vs. 2.1 days (laparoscopic vs. open appendectomy, period III). There was a significant decrease in the percentage of perforated cases in which surgical treatment had been delayed (>8 hours) (21%, 5%, and 5%) over the three time periods, but the rate of "negative" appendectomies was similar (10%, 8%, and 8%). The complication rates following laparoscopic and open appendectomies during period II were 5.4% and 7.5%, respectively (P >0.05). Laparoscopic appendectomy results in a marked decrease in the length of hospital stay and similar postoperative morbidity compared to open appendectomy. In cases of gangrenous or perforated appendicitis, laparoscopic appendectomy appears to be especially worthwhile in regard to both operating room time and hospital stay. Presented at the Thirty-Ninth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, La., May 17–20, 1998. Supported by the Harvard Center for Minimally Invasive Surgery.     

阑尾切除术采用微小切口的临床研究

目的　减少阑尾切除手术创伤 ,探索采用微小切口的手术方法和技巧。方法　应用腹腔镜辅助微小切口和直视下小横切口两种方法完成阑尾切除术 6 0例 ,用同期传统麦氏切口阑尾切除术 30例作对照。将手术时间、切口长度、下床时间、进食时间、住院时间、镇痛剂使用和切口感染率进行比较。结果　腹腔镜辅助微小切口阑尾切除术 ,除术后未用镇痛剂及切口无感染外 ,在手术时间、切口长度、下床时间、进食时间、住院时间等方面 ,均较其他两种手术明显缩短 ,差异有显著意义 (P<0 .0 1)。直视下小横切口阑尾切除术 ,较传统麦氏切口阑尾切除术的下床活动、进食时间也有提早(P <0 .0 1)。结论　腹腔镜辅助微小切口阑尾切除术 ,发挥了腹腔镜手术与开腹手术的优点 ,方法简便 ,具有微创意义和推广价值。直视下小横切口阑尾切除术 ,在具有一定经验和掌握手术技巧后应用 ,似较麦氏切口手术优越