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。     

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。     

改良经脐单孔腹腔镜阑尾切除术的临床分析(附55例报告)

目的:探讨改良经脐单孔腹腔镜阑尾切除术(laparoscopic appendectomy,LA)治疗青少年及儿童急性阑尾炎的临床应用价值。方法:回顾分析2015年9月至2017年3月为55例急性阑尾炎患儿行改良经脐单孔LA的临床资料,术中使用常规腹腔镜器械操作。结果:55例患儿中50例成功完成手术,5例因化脓、粘连严重中转为三孔法LA,手术成功率90.9%。手术时间平均(45.55±6.33)min,术中出血量平均(5.25±1.10)ml,术后排气时间平均(12.20±4.24)h,平均住院(5.60±1.42)d,55例均治愈出院,无一例发生腹腔残余感染及切口感染。术后病理证实急性单纯性阑尾炎44例,化脓性阑尾炎11例。术后随访3～9个月,无粘连性肠梗阻、脐疝等并发症发生。结论:对于青少年及儿童急性阑尾炎,改良经脐单孔LA优势明显,值得临床推广应用。     

自制阑尾把持器在腹腔镜阑尾切除术中的应用

目的探讨自制阑尾把持器在腹腔镜阑尾切除手术中的作用。方法回顾性分析2003年5月-2005年1月，我们使用自制阑尾把持器进行腹腔镜阑尾切除术（laparoscopic appendectomy．LA）145例的临床资料。其中急性单纯性阑尾炎35例，急性化脓性阑尾炎67例，坏疽穿孔性阑尾炎28例，慢性阑尾炎10例，阑尾周围脓肿5例。结果145例均获成功，无一例中转开腹。手术时间8—52min，平均36．3min。术后并发症包括5例（3．4％）术后穿刺处皮下气肿，术后1d完全吸收；2例（1．4％）trocar孔感染，经换药后痊愈。住院1—5d，平均3．6d。124例（85．5％）随访3—24个月，平均8．5月，未发现肠粘连、肠梗阻、切口疝、阑尾残端瘘等并发症。结论自制阑尾把持器在腹腔镜阑尾切除手术中手术显露好、操作方便、适应证广，值得推广。     

基层医院开展腹腔镜阑尾切除术

目的探讨腹腔镜阑尾切除术（laparoscopic appendectomy,LA）治疗阑尾炎的疗效。方法2007年7月~2008年10月行LA64例,在气管插管全麻下,头低脚高仰卧位,三孔法,超声刀切断阑尾系膜及阑尾根部,打结法结扎阑尾根部。结果64例LA顺利完成手术,术中发现阑尾周围粘连严重5例（阑尾周围脓肿3~6个月后）,阑尾坏疽穿孔4例,腹腔脓液较多合并弥漫性腹膜炎3例,均放置引流管。手术时间30-110min,平均35min。住院时间3~7d,平均4d。1例术中发现结核性腹膜炎;1例戳孔（脐部）感染经换药治疗痊愈;1例术后B超提示右髂窝少量积液,保守治疗治愈。49例术后随访3~6个月,平均4.5月,无术后出血、残株炎、盆腔脓肿、肠粘连等并发症。结论LA治疗阑尾炎效果满意,安全可行,操作简单,可在基层医院应用和推广。     

Lapro—Clip可吸收生物夹在腹腔镜阑尾切除术中的应用

目的探讨在腹腔镜阑尾切除术（1aparoscopicappendectomy,LA）中应用Lapro．Clip可吸收生物夹的优势。方法回顾性分析2011年7月至2013年4月期间于秦皇岛市抚宁县人民医院微创外科施行LA术的294例阑尾炎患者的临床资料,对其效果进行分析和评价。结果294例阑尾炎患者行LA术时,均采用Lapro．Clip可吸收生物夹（12mm）处理阑尾及其系膜。所有患者术中出血均〈10mL,手术时间13～48min（平均24min）。住院时间为2～7d（平均4d）。术后均无切口感染、肠瘘、腹腔出血、粘连性肠梗阻等并发症发生。术后以电话随访294例,随访时间为3～12个月,平均6个月,均无腹胀、腹痛等并发症发生。结论LA术中应用Lapro-Clip可吸收生物夹处理阑尾根部及其系膜的操作简单、安全,能节省手术时间。     

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。     

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。     

改良悬吊固定法在腹腔镜阑尾切除术中的应用

目的探讨改良悬吊固定法在腹腔镜阑尾切除术中的临床应用价值。方法对我科在2008年1月．2008年8月诊断的急慢性阑尾炎的22例患者,采用改良悬吊固定法,行三孔法腹腔镜阑尾切除术进行回顾性分析。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30min,比常规腹腔镜阑尾炎（LA）缩短10—15min,平均住院3d。结论改良悬吊固定法LA较非固定LA具有简单易行,手术时间短,安全快捷。     

脐部单孔法腹腔镜小儿阑尾切除术

目的 探讨脐部单孔法腹腔镜阑尾切除术的可行性。方法34例小儿急性阑尾炎在外径10mm带有5mm器械操作孔道的腹腔镜下采用脐部单孔法行腹腔镜阑尾切除术，在腹腔镜下提出阑尾，腹腔外常规开腹法切除阑尾。结果手术时间10～50min，平均22min。术后排气时间6～23h，平均14．5h。术后住院3～7d，平均4．5d。切口全部一期愈合，无切口感染及肠梗阻等并发症。34例随访6～12个月，平均10个月，无并发症。腹部未见切口瘢痕。结论脐部单孔法腹腔镜阑尾切除术可行。     

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。     

腹腔镜下阑尾残端的处理体会

目的:研究腹腔镜阑尾切除术(laparoscopic appendectomy,LA)术中阑尾残端的处理方法。方法:收集2010年10月至2016年4月448例行LA患者的临床资料。术中采取3种方法处理阑尾残端:应用套扎线行阑尾残端双重套扎(套扎法,n=312)、荷包缝合阑尾残端(荷包缝合法,n=112)、可吸收线缝合阑尾残端(可吸收线缝合法,n=24)。结果:套扎法312例患者基本恢复良好,术后11例出现右下腹轻微痛,2～3 d后消失。荷包缝合法112例患者术后恢复良好。可吸收线缝合法24例患者术后基本恢复良好,3例化脓性阑尾炎患者术后出现发热、腹痛,2～4 d后排气,症状消失。结论:LA术中处理阑尾残端应遵循开腹手术的处理原则,套扎阑尾残端方便可行,节省时间;荷包缝合包埋法是首选方法;可吸收线缝合阑尾残端适于阑尾根部坏疽的患者。     

腹腔镜阑尾切除术238例临床分析

目的:探讨腹腔镜阑尾切除术(laparoscopic appendectomy,LA)的临床应用价值。方法:回顾分析1993年1月至2009年12月为238例患者施行腹腔镜阑尾切除术的临床资料。结果:235例成功完成LA,3例中转开腹,手术时间15～80min,平均(56.25±10.20)min;术中出血5～50ml,平均(10.3±8.5)ml;术后应用抗生素时间平均(3.1±1.4)d;术后住院2～8d,平均3.5d。随访173例(72.7%),随访时间3～130个月,平均52个月,除1例切口脂肪液化感染外,未发生肠漏、残株炎、腹腔脓肿、粘连性肠梗阻、切口疝等手术并发症。结论:LA治疗阑尾炎安全、有效,具有患者创伤小、痛苦轻、术后住院时间短、康复快、美容效果好、并发症少等特点,另外,能同时诊断和治疗腹腔内其他疾病,特别适于多种腹腔疾病联合手术者,以及肥胖、诊断不明确、异位阑尾患者及育龄期妇女。     

Laparoscopic appendectomy in pregnancy

BACKGROUND: Laparoscopic appendectomy (LA) is a safe, effective, and beneficial procedure for the treatment of acute appendicitis. However, limited data are available regarding the safety and feasibility of LA during pregnancy. METHODS: Between January 2001 and August 2004, 1235 patients with clinically suspected appendicitis underwent laparoscopic surgery at our hospital. Eleven patients (0.9%) were pregnant women (mean age, 25 years; age range, 19-37 years; range of gestational age, 4-30 weeks). Clinical data collected retrospectively included demographic information; preoperative, procedural, and postoperative information; and outcome of the pregnancy. RESULTS: All 11 pregnant women underwent laparoscopic surgery without need of conversion. Ten patients underwent LA and were found to have acute appendicitis on histologic analysis. One patient had torsion of the right fallopian tube and a healthy-looking appendix; she underwent detorsion of the fallopian tube and incidental appendectomy. Mean operative time was 50.5 minutes (range, 20-135 minutes). Length of postoperative hospital stay averaged 4.2 days (range, 1-11 days). One patient had a surgical wound infection, which was managed conservatively. Mean follow-up period was 14 months (range, 2-46 months). Seven pregnant women delivered healthy term infants, 2 had planned abortions, and 1 experienced fetal loss due to uterine infection and premature contractions 1 month after LA. Another patient had normal results at prenatal examination. CONCLUSION: Our data support the accumulating evidence that LA is a safe and feasible procedure for the treatment of acute appendicitis in all trimesters of pregnancy. Close maternal and fetal monitoring is essential during and after the operation.     

腹腔镜阑尾切除术用于女性患者的远期疗效

目的:评价腹腔镜阑尾切除术用于治疗女性阑尾炎的远期效果。方法:回顾分析2004年2月至2008年2月因阑尾炎入院的157例女性患者的临床资料,其中传统开腹手术组84例,腹腔镜手术组73例,比较两组术后病理、切口感染率、腹腔残余脓肿、粘连性肠梗阻等并发症,评估腹腔镜阑尾切除术预防盆腔炎和不孕症的效果。结果:两组切口感染率、腹腔残余脓肿、粘连性肠梗阻、盆腔炎发生率和术后住院时间差异有统计学意义(P0.05)。结论:女性阑尾炎患者特别是孕龄女性,建议行腹腔镜阑尾切除术。     

Infectious complications following laparoscopic appendectomy.

INTRODUCTION: A meta-analysis of the literature suggests there is an increased rate of intra-abdominal abscess after laparoscopic appendectomy (LA) compared with open appendectomy (OA). METHODS: To analyze the infectious complications of LA at one tertiary care centre, we completed a retrospective chart review for all patients undergoing LA for acute appendicitis from 1995 to 2002. RESULTS: We used established exclusion criteria to identify 175 patients with a mean age of 37.6 (standard deviation [SD] 14.5) years (95 male, 80 female). The mean operating time was 61.9 (SD 22.5) minutes. Excluding conversions to OA (14/175, 8%), operating time was 59.9 (SD 20.5) minutes. On surgical assessment, 143 patients had acute nonperforated appendicitis (17 perforated, 15 gangrenous). However, on histopathology assessment, 13 cases of normal appendix were identified (13/175, 7.4%). The overall median length of stay was 2.0 days. Three patients had significant postoperative infectious complications, including 1 wound infection and 2 cases of intra-abdominal abscesses. All abscesses were managed successfully with percutaneous drainage. An analysis of perioperative factors that might have contributed to the infectious complications revealed that each case of postoperative intra-abdominal abscess occurred in patients with gangrenous appendicitis and when extensive irrigation was used during LA. CONCLUSIONS: An institutional review demonstrates outcomes comparable with the Cochrane systematic review of the published literature. Technical issues that may impact on intra-abdominal abscess formation after LA include aggressive manipulation of the infected appendix and increased use of irrigation fluid, possibly producing greater contamination of the peritoneal cavity.     

Retrospective evaluation of carcinoid tumors of the appendix in children

Carcinoids of the appendix are rare in children and are usually diagnosed incidentally on histologic investigation following appendectomy for appendicitis. To investigate the significance of the diagnosis of appendiceal carcinoid in children, we conducted a retrospective study of the treatment and follow-up of 36 children with histologically confirmed carcinoid tumors of the appendix. Between 1970 and 2000 a total of 36 patients (25 girls, 11 boys) were diagnosed with appendiceal carcinoid. The median age of the patients at diagnosis was 12.3 years (range 6-16 years). The indication for appendectomy was acute lower right quadrant pain in 27 cases and chronic right lower quadrant pain in 9 patients. In 27 specimens the tumor was localized at the apex, in 7 at the midportion, and in 2 at the base of the appendix. The median tumor diameter was 6 mm (range 3-17 mm). Concomitant severe appendicitis was diagnosed in 14 patients 2 with a perforated appendicitis. In only one tumor were mucin-producing cells detectable. After a median follow-up of 10 years (range 2 months to 30 years) all patients were tumor-free. None of the patients had a synchronous or metachronous noncarcinoid malignant tumor. Appendiceal carcinoids are usually asymptomatic, and the indication for surgical intervention is acute or chronic abdominal pains in the right lower quadrant. For most patients the prognosis is excellent after appendectomy. As in adults, appendectomy is the appropriate treatment.     

Laparoscopic appendectomy with endoloop: results of our experience

There are several different techniques for laparoscopic appendectomy (LA), with different material requirements and approach. We present the results from our series, where we employ monopolar hook for mesoappendix dissection and double polyglactin endoloop for ligation of appendicular stump. The appendix is taken out through the Hasson trocar without any contact with abdominal wall, in a completely laparoscopic procedure. We sought to analyze the security of this technique. We reviewed retrospectively every LA for acute appendicitis performed during the last 10 years in our Hospital. We collected data regarding surgical procedure and postoperative outcome, focusing on intraoperative or postoperative complications. A total of hundred and ten (110) LA for acute appendicitis (from simple appendicitis to perforated appendicitis) were performed. Mean operative time was 74.7 minutes (median 70 min, SD 24.43 min, min. 25, max. 130 min). Ten patients (9.09%) had postoperative complications, consisting in intraabdominal abscess in 6 patients (5.4%) and wound infection in 3 patients (2.7%). No major complication was found, as uncontrolled hemorrhage, bowel perforation or stump dehiscence. No patient needed a second surgical procedure in the postoperative time. Laparoscopic appendectomy with polyglactin endoloops is a completely laparoscopic and safe procedure, without any intraoperative complication in our series. Laparoscopic approach with 12 mm Hasson trocar and two 5 mm working trocars allows a nice aesthetic result.     

Crohn's disease of the appendix]

22 cases of primary involvement of the appendix in Crohn's disease are reported in the literature. During the last 3 years we observed 4 cases. In three patients typical clinical signs of acute appendicitis were present. One case was found occasionally. The follow-up was 5-30 months. During this time none of our patients showed symptoms of granulomatous enterocolitis in other regions of the bowel. Reviewing the literature 3 of 26 patients (11.5%) showed lesions typical for Crohn's disease elsewhere in the intestine 3-48 months after appendectomy. But two cases had a follow-up of 5 years which time is considered indispensable before one can admit that the disease is really limited to the appendix.     

阑尾不同部位化脓性病变与并发门静脉炎的临床观察

为分析阑尾不同部位化脓性病变与并发门静脉炎的关系，对３５年中收治的１６８３例急性化脓及坏疽性阑尾炎患者进行了回顾性分析。其中有２５例并发或术后出现门静脉炎或／和肝脓肿。经术中肉眼观察，阑尾远端病变５２７例，２例（０．３７％）并发或术后出现门静脉炎或／和肝脓肿；中远端病变８４０例，６例（０．７１％）并发或术后出现门静脉炎或／和肝脓肿；近端病变（阑尾整个病变）３１６例，１７例（５．３７％）并发或术后出现门静脉炎或／和肝脓肿。２５例门静脉炎或／和肝脓肿中１６例是在切除阑尾手术后才出现寒颤、高热等门静脉炎症状的。本组资料表明，阑尾近端的化脓性病变较之中、远段病变易于发生门静脉炎或／和肝脓肿