经脐单孔腹腔镜手术治疗小儿复杂性阑尾炎的效果分析

目的分析经脐单孔腹腔镜手术治疗小儿复杂性阑尾炎的效果。方法选择2017-07～2019-10该院收治的复杂性阑尾炎患儿86例,采用随机数字表法将其分为开腹手术组和经脐单孔腹腔镜组,每组43例。开腹手术组行传统开腹手术治疗,经脐单孔腹腔镜组行经脐单孔腹腔镜手术治疗,对比两组患儿的治疗效果。结果经脐单孔腹腔镜组手术时间、手术切口长度、术后肛门排气时间、首次下床活动时间、引流时间和住院时间均明显短于开腹手术组(P 0.05),术中出血量明显少于开腹手术组(P 0.05)。经脐单孔腹腔镜组术后视觉模拟量表(VAS)疼痛评分、止痛药使用率、并发症发生率均显著低于开腹手术组(P 0.05)。两组患儿术后第3天的白细胞(WBC)、C-反应蛋白(CRP)水平均较术前显著降低(P 0.05);但两组术前、术后第3天比较差异无统计学意义(P 0.05)。结论经脐单孔腹腔镜手术治疗小儿复杂性阑尾炎具有较好的临床效果,可准确定位坏死阑尾,有效减轻术后疼痛,术后并发症较少,术后恢复快。     

腹腔镜与开腹手术治疗复杂性阑尾炎的效果对比观察及价值分析

目的腹腔镜与开腹手术治疗复杂性阑尾炎的效果对比观察及价值分析。方法选取我院2017年1月-2019年4月收治的65例复杂性阑尾炎患者为研究对象,根据奇数偶数法将患者分为常规组(n=32)和研究组(n=33),常规组采用开腹手术进行治疗;研究组患者采用腹腔镜手术进行治疗。比较两组患者的手术时间、术中出血量、肛门排气时间、住院时间以及术后患者并发症发生率。结果研究组患者的手术时间、术中出血量、肛门排气时间和住院时间均优于常规组,患者术后并发症发生率也小于常规组,差异具有统计学意义(P<0.05)。结论腹腔镜手术治疗复杂性阑尾炎患者有着明显的疗效,临床效果更佳。     

内镜逆行阑尾炎治疗术与腹腔镜阑尾切除术治疗急性非复杂性阑尾炎的疗效对比研究

目的 比较内镜逆行阑尾炎治疗术(ERAT)与腹腔镜阑尾切除术(LA)在治疗急性非复杂性阑尾炎(UCAA)中的疗效。方法 以2020年8月至2023年8月中山市人民医院黄圃院区消化内科收治的80例急性非复杂性阑尾炎患者作为本研究研究对象,根据患者是否愿意进行ERAT治疗进行分组,将患者分为ERAT组(n=40)和LA组(n=40)。ERAT组行ERAT术,LA组行LA术,比较两组患者手术相关指标(手术时间、术后卧床时间、住院时间、术中出血量)、炎症指标(IL-6、CRP、PCT、TNF-α)及疼痛介质指标(DA、SP、5-HT、PGE2)及术后并发症(消化道出血、切口感染、腹腔脓肿、肠梗阻)发生情况。结果 ERAT组患者的手术时间、术后卧床时间、住院时间均较LA组显着缩短,同时ERAT组的术中出血量也较LA组明显减少(P<0.05)。ERAT组与LA组两组患者的炎症指标(IL-6、CRP、PCT、TNF-α)水平均较术前上升,ERAT组炎症指标(IL-6、CRP、PCT、TNF-α)均显着低于LA组(P<0.05)。ERAT组患者术后并发症发生率明显低于LA组(P<0....     

腹腔镜阑尾炎手术治疗小儿阑尾炎的临床效果及安全性

目的:对比分析腹腔镜阑尾炎手术与传统开腹手术治疗小儿阑尾炎效果,分析其安全性及应用价值.方法:选择2017年10月～2019年10月在我院收治的126例小儿阑尾炎患者作为观察对象,根据患儿家长的意愿选择不同的手术方式对患儿进行治疗,并将患儿分为开腹组和腹腔镜组,每组各63例,分析患儿手术疗效差异性.结果:手术时间方面,...     

腹腔镜阑尾切除术治疗老年急性阑尾炎的疗效

目的探讨腹腔镜阑尾切除术治疗老年急性阑尾炎的疗效及影响。方法 134例老年急性阑尾炎患者,其中开腹组51例行开腹阑尾切除术,腹腔镜组83例行腹腔镜阑尾切除术。比较两组手术时间、术中出血量、病理类型、肛门排气时间、住院时间、生活质量评分以及并发症发生率。结果腹腔镜组手术时间、术中出血量、病理类型与开腹组比较差异无统计学意义(P>0.05)。腹腔镜组肛门排气时间、住院时间、生活质量评分、并发症发生率均明显优于开腹组。结论采用腹腔镜阑尾切除术治疗老年急性阑尾炎相比开腹手术有明显优势,具有很好的临床应用价值。     

腹腔镜阑尾切除术治疗阑尾炎31例疗效分析

2003年7月～20008年2月,我们对31例阑尾炎患者行腹腔镜阑尾切除(LA)或LA附加引流(LD),效果满意.现报告如下.     

腹腔镜阑尾切除术与开腹阑尾切除术对比研究

目的 比较腹腔镜阑尾切除术(LA)与开腹阑尾切除术(OA)临床疗效.方法 随机对2004-02～2008-10腹腔镜阑尾切除术(n=128)和开腹阑尾切除术(n=108)进行比较.结果 腹腔镜阑尾切除术在肠道功能恢复时间和住院时间均较开腹阑尾切除术短(P<0.01);在切口感染发生率方面,腹腔镜阑尾切除术较开腹手术明显降低.而在麻醉时间和手术时间均比开腹阑尾切除术长(P<0.01).结论 腹腔镜阑尾切除术具有创伤小、恢复快、住院时间短及切口感染发生率低等优点.     

特殊类型阑尾炎患者的腹腔镜尾切除术

探讨了大腹腔镜外科手术的适应证范围。方法患急性尾孕妇３例（妊娠２．５－６．５个月），老年患者１２例（６０－７０岁），年幼患者５例（１１－１５岁），胆囊旁阑尾声例，盆腔位阑尾４例，蛔虫性阑尾炎１例，作了腹腔镜阑尾切除术。结果２５例均成功完成手术，手术时间平均３０．５分钟。     

单孔法腹腔镜小儿阑尾切除90例

我院自2003年3月至2003年9月，对90例急性单纯性阑尾炎和急性化脓性阑尾炎患儿行脐部单孔法腹腔镜阑尾切除术（umbilical one-lrocar laparoscopic appendectomy，UOTLA），又称无瘢痕小儿阑尾切除术，疗效满意，现报道如下。     

腹腔镜治疗阑尾炎并阑尾穿孔42例体会

近年来 ,本院采用腹腔镜治疗阑尾炎并阑尾穿孔 42例。报告如下。临床资料 :选取阑尾炎并阑尾穿孔患者 96例 ,男 5 1例 ,女 45例 ,年龄 18～ 35岁。临床表现为转移性右下腹痛 ,查体示右下腹麦氏点压痛 (+) ,反跳痛 (+) ,腹透均未见异常 ,血常规示血白细胞升高。 96例患者中 5 4例行剖腹探查 +阑尾切除术 ,42例行腹腔镜阑尾切除术。手术方法 :1施行腹腔镜阑尾切除术 (L A) ,术前需排空膀胱或留置尿管。患者取平卧位。在脐部作一长 1cm横行切口 (可以在脐上或脐下或左侧 ) ,插入气腹针 ,由注水法或试压证实确实在腹腔内 ,二氧化碳气腹压。 1.5…     

Results of laparoscopicvs. conventional appendectomy in complicated appendicitis

BACKGROUND: Although many trials show some advantages of laparoscopic appendectomy over open appendectomy, the value of laparoscopic appendectomy is still controversial. Specifically the question of whether there are benefits of laparoscopic appendectomy over open appendectomy in complicated appendicitis remains to be answered. METHODS: Of 1,106 consecutive appendectomies (717 laparoscopic appendectomies, 330 open appendectomies, and 59 conversions) between 1989 and 1999, the results of 299 patients with complicated appendicitis (defined by perforation, abscess, or peritonitis) were analyzed retrospectively to compare the complications of laparoscopic appendectomy and conversion (intention-to-treat group) with those of open appendectomy. RESULTS: Complicated appendicitis (n=299) was treated by laparoscopic appendectomy in 171 patients, by open appendectomy in 82 patients, and by conversion in 46 patients. Laparoscopic appendectomy and conversion showed fewer abdominal wall complications than open appendectomy (13/217; 6 percentvs. 15/82; 18.3 percent;P<0.003), which led to a decrease of the total complication rate in the intention-to-treat group (21/217; 9.7 percentvs. 19/82; 23.1 percent;P=0.004). The rate of intra-abdominal abscess formation was nearly the same after laparoscopic appendectomy (4.1 percent) and open appendectomy (4.9 percent). The total complication rate was higher in complicated appendicitis than in acute appendicitis (P<0.005) but was independent of the laparoscopic technique. The conversion rate was higher in complicated appendicitis than in acute appendicitis (21.2vs. 2.3 percent;P<0.001). CONCLUSION: In comparison with open appendectomy, laparoscopic appendectomy (by itself and in an intention-to-treat view) leads to a significant reduction of early postoperative complications in complicated appendicitis and therefore should be considered as the procedure of choice.Preliminary results of our first laparoscopically treated patients were presented in 1998 in German (Barkhausen S, Wullstein C, Gross E. Laparoskopische versus konventionelle Appendektomie—ein Vergleich hinsichtlich der frühpostoperativen Komplikationen. Zentralbl Chir 1998;123:858–62).     

New strategy during complicated open appendectomy: Convert open operation to laparoscopy

AIM: To introduce a new strategy during complicated open appendectomy - converting open operation to laparoscopy.METHODS: We retrospectively reviewed databases at two institutions between October 2010 and January 2013, identifying 826 patients who had undergone complicated appendectomy for histologically confirmed acute or chronic appendicitis. They included 214 complicated appendectomies: 155 lengthened-incision open appendectomies (LIA group) and 59 open appendectomies with conversion to laparoscopy (OACL group).RESULTS: A total of 214 patients with complicated appendectomies were included in the study, including 155 cases of LIA and 59 cases of OACL. No major complication leading to death occurred in the study. Patient characteristics of the two groups were similar. Several parameters showed a significant difference between the two groups. For the OACL vs LIA groups they were, respectively: incision length (3.8 ± 1.4 cm vs 6.2 ± 3.5 cm, P < 0.05); time to flatus recovery (2.3 ± 0.6 d vs 4.2 ± 0.8 d, P < 0.05), drainage rate (61.0% vs 80.0%, P < 0.05); pain level (3.6 ± 1.8 vs 7.2 ± 2.4, P < 0.05); hospital stay (5.1 ± 2.7 d vs 8.7 ± 3.2 d, P < 0.05); complication rate (8.5% vs 14.7%, P < 0.05). Other factors showed no significant differences.CONCLUSION: Lengthened-incision open appendectomy increases the incidence of complications and prolongs the hospital stay. Conversion of open to laparoscopic appendectomy is feasible and efficient in complicated cases. It decreases the rate of incisional and abdominal infections, allows faster return of bowel movements, and shortens the hospital stay.     

Laparoscopic treatment of perforated appendicitis

The use of laparoscopy has been established in improving perioperative and postoperative outcomes for patients with simple appendicitis. Laparoscopic appendectomy is associated with less wound pain, less wound infection, a shorter hospital stay, and faster overall recovery when compared to the open appendectomy for uncomplicated cases. In the past two decades, the use of laparoscopy for the treatment of perforated appendicitis to take the advantages of minimally invasiveness has increased. This article reviewed the prevalence, approaches, safety disclaimers, perioperative and postoperative outcomes of the laparoscopic appendectomy in the treatment of patients with perforated appendicitis. Special issues including the conversion, interval appendectomy, laparoscopic approach for elderly or obese patient are also discussed to define the role of laparoscopic treatment for patients with perforated appendicitis.     

Stump appendicitis is a rare delayed complication of appendectomy： A case report

INTRODUCTIONStump appendicitis is an acute in? ammation of the residual appendix and a rare complication after appendectomy[1]. Although the signs and symptoms do not differ from those of acute appendicitis, the diagnosis is often not considered because o…     

Laparoscopic Versus Open Appendectomy: A Comparison of Primary Outcome Measures

Background/Aim:

The aim of the study was to compare laparoscopic and open appendectomy (OA) in terms of primary outcome measures. Study design: A randomized controlled trial. Place and duration of the study: Khyber Teaching Hospital, Peshawar, Pakistan, February 2008 to December 2009.

Patients and Methods:

A total of 160 patients were divided into two groups, A and B. Group A patients were subjected to laparoscopic appendectomy (LA), whereas Group B patients were subjected to OA. Data regarding age, gender, and primary outcome measures, such as hospital stay, operative duration, and postoperative complication, were recorded and analyzed. Percentages were calculated for categorical data, whereas numerical data were represented as mean ± SD. Chi-square test and t test were used to compare categorical and numerical variables, respectively. Probability ≤ 0.05 (P ≤ 0.05) was considered significant.

Results:

After randomization, 72 patients in group A and 75 patients in group B were analyzed. The mean age of patients in groups A and B was 23.09 ± 8.51 and 23.12 ± 10.42 years, respectively, (P = 0.981). The mean hospital stay was 1.52 ± 0.76 days in group A and 1.70 ± 1.06 days in group B (P = 0.294). The mean operative duration in group A and B were 47.54 ± 12.82 min and 31.36 ± 11.43 min, respectively (P < 0.001). Pain (overall level) was significantly less in group A compared with group B (P = 0.004). The two groups were comparable in terms of other postoperative complications, such as hematoma (P = 0.87), paralytic ileus (P = 0.086), urinary retention (P = 0.504), and wound infection (P = 0.134).

Conclusion:

LA is an equivalent procedure and not superior to OA in terms of primary outcome measures.     

What is the optimal treatment for appendiceal mass formed after acute perforated appendicitis

We read with great interest the editorial article by Meshikhes AWN published in issue 25 of World J Gastroenterol 2011. The article described the advantages of emergency laparoscopic appendectomy compared with interval appendectomy as a new safe treatment modality for the appendiceal mass. The author concluded that the emergency laparoscopic appendectomy was a safe treatment modality for the appendiceal mass, and might prove to be more cost-effective than conservative treatment, with no need for interval appendectomy. However, we would like to highlight certain issues regarding the possibility of percutaneous catheter drainage to successfully treat the appendiceal mass, with no need for appendectomy, too.     

Laparoscopic versus open Frey procedure: Comparative analysis of short and long-term outcomes

BackgroundFrey procedure is one of the most common surgical treatment options for chronic pancreatitis. The data on safety and effectiveness of laparoscopic approach in Frey procedure are very limited. In the present study a comparative analysis of the short- and long-term outcomes of laparoscopic versus open Frey procedure was demonstrated.MethodsSeventy-nine consecutive patients with chronic pancreatitis submitted to either open (n – 29) (OFP) or laparoscopic (n – 50) (LFP) Frey procedure between September 2012 and January 2020, were evaluated.ResultsThe laparoscopic approach was performed fully on 45 (90%) patients. Conversion was needed in 4 (8%) cases, 1 patient (2%) was converted to laparoscopic Beger procedure. The median operative time was 420 (290–685) min after LFP and 310 (179–515) min after OFP. The blood loss was 100 (30–700) ml and 225 (50–1200) ml, respectively. The pain score on POD 3 was 2 (1–4) in LFP group and 4 (2–8) after OFP. The length of hospital stay was 6 (3–25) days after LFP and 9.5 (5–42) days after OFP. In the LFP and OFP groups the postoperative complications occurred in 11 (24.4%) and 8 (28.5%) patients, respectively. The follow-up period lasted for 36 (6–60) months after LFP and 60 (6–60) months after OFP. Poor pain control with the need for non-opioid analgesics intake was observed in 4 patients in the LFP group and in 3 patients after OFP.ConclusionsLaparoscopic Frey procedure is an efficient and safe intervention, which provides all the advantages of the minimally invasive approach.     

老年急性阑尾炎行腹腔镜与开腹手术的对比分析

目的对比分析腹腔镜(LA)和开腹阑尾切除术(OA)治疗老年急性阑尾炎的手术效果。方法2003年1月至2006年1月行阑尾切除术治疗老年阑尾炎56例,其中LA27例,OA29例。比较2种术式的手术时间、下床活动时间、术后排气时间、疼痛评分、误诊率、止痛药使用率、切口感染率、置管引流率、残余脓肿发生率、住院时间和综合费用。结果LA组和OA组以上各指标(除手术时间和综合费用外)差异均有统计学意义(P<0.05)。结论对于老年急性阑尾炎,和OA相比,LA具有创伤小、恢复快、并发症少和平均住院时间短等优点,值得临床推广。     

阑尾血吸虫病并发急性阑尾炎临床分析

回顾性分析275例阑尾血吸虫病并发急性阑尾炎患者的临床资料,结果表明血吸虫病流行区阑尾血吸虫病并发急性阑尾炎发病率较高,并发症严重,应引起高度重视。