急性阑尾炎行腹腔镜手术与开腹手术的比较

目的对比分析腹腔镜与开腹阑尾切除术在治疗急性阑尾炎中的手术效果。方法回顾性分析2009年1月至2011年10月58例行腹腔镜阑尾切除术（LA组）和同期55例行开腹阑尾切除术（OA组）的急性阑尾炎患者的临床资料,比较两种术式手术时间、下床活动时间、术后排气时间、止痛药物使用率、并发症发生率、住院时间及综合费用等指标。结果 LA组与OA组相比上述指标除手术时间外差异均有统计学意义（P〈0.05）。结论腹腔镜阑尾切除术治疗急性阑尾炎具有创伤小、恢复快、并发症少和住院时间短等优点,可作为治疗急性阑尾炎的理想选择。     

腹腔镜与开腹阑尾切除术治疗穿孔性阑尾炎的比较

目的 对比分析腹腔镜与开腹阑尾切除术在治疗穿孔性阑尾炎中的手术效果. 方法 回顾性分析比较我院2002年1月～2005年12月20例腹腔镜阑尾切除术(laparoscopic appendectomy, LA)和20例(open appendectomy,OA)的穿孔性阑尾炎手术的临床资料. 结果 LA组手术时间(75.8±11.6)min明显长于OA组(54.8±9.5)min(t=6.264,P=0.000).LA组术后进食时间(1.8±0.5)d明显短于OA组(2.6±0.5)d(t=-5.060,P=0.000).LA组术后抗生素使用时间(3.8±0.7)d显著短于OA组(6.3±1.2)d(t=-8.048,P=0.000).LA组住院时间(5.8±1.1)d显著短于OA组(11.6±1.6)d(t=-13.359,P=0.000).术后切口感染并发症发生率LA组(0/20)与OA组(3/20)无显著差异(Fisher确切概率法,P＝0.115). 结论 LA治疗穿孔性阑尾炎较OA具有创伤小、恢复快、住院时间短、抗生素用量少等特点,可作为穿孔性阑尾炎一种安全、有效的治疗方法.     

急性阑尾炎腹腔镜与开腹手术的对比分析

目的 探讨腹腔镜阑尾切除术(laparoscopic appendectomy,LA)治疗急性阑尾炎的价值.方法 比较2008年5月～2010年5月95例急性阑尾炎行腹腔镜阑尾切除术(LA组)与87例行开腹阑尾切除术(OA组)的临床资料.结果 LA组93例手术成功,2例中转开腹:1例因阑尾粘连严重,分离困难;l例为阑尾根部坏疽穿孔,切除困难.术后切口感染1例,无腹腔残余脓肿、粘连性肠梗阻,并发症发生率为1.1％ (1/93).OA组切口感染6例(6.9％),腹腔残余脓肿4例(4.6％),粘连性肠梗阻4例(4.6％),并发症发生率为16.1％ (14/87),显著高于LA组(x2=13.269,P=0.000).LA组和OA组手术时间分别为(45.2±10.7)min和(42.5±12.3)min,无统计学差异(t=1.574,P=0.117);LA组术后排气时间(22.7±6.3)h,显著短于OA组(36.4±9.1)h(t=11.807,P=0.000);LA组住院时间(3.8±1.6)d,显著短于OA组(7.4±3.1)d有统计学差异(t=9.881,P=0.000);LA组术后镇痛剂使用率3.2％(3/93),显著低于OA组18.4％ (16/87)(x2=10.949,P =0.001).结论 与0A比较,LA具有疼痛轻、恢复快、住院时间短、并发症少等优点.     

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。     

腹腔镜与开腹阑尾切除术治疗急性阑尾炎的效果分析

目的比较腹腔镜阑尾切除术(LA)与开腹阑尾切除术(OA)治疗急性阑尾炎的效果。方法随机将2016-03—2019-03间新郑市人民医院收治的188例急性阑尾炎患者分为2组,每组94例。对照组行OA,观察组行LA。结果观察组的手术时间及术后使用镇痛药例数、TNF-α等创伤反应指标水平、下床活动时间、胃肠功能恢复时间、并发症总发生率和住院时间均优于对照组,差异有统计学意义(P0.05)。结论对急性阑尾炎患者实施LA,创伤小、患者术后疼痛轻微、并发症发生率降低,有利于患者术后恢复。     

腹腔镜手术治疗急性阑尾炎并穿孔256例报告

目的:探讨腹腔镜阑尾切除术治疗急性阑尾炎并穿孔的手术方法、指征、并发症及效果.方法:回顾分析2006年7月至2010年6月为256例急性阑尾炎并穿孔患者行腹腔镜手术的临床资料.结果:256例手术均获成功,无一例中转开腹.手术时间35～110 min,平均55 min,术中出血量5～20 ml,术后排气时间平均19.5 ...     

根部坏疽穿孔性阑尾炎腹腔镜与开腹阑尾切除术的临床对比研究

目的探讨根部坏疽穿孔性阑尾炎腹腔镜与开腹阑尾切除术的效果。方法前瞻性纳入2019-01—2020-01间于兰考第一医院行阑尾切除术的57例根部坏疽穿孔性阑尾炎患者,根据手术方式分为2组。开腹组30例行开腹阑尾切除术,腔镜组27例行腹腔镜阑尾切除术(LA)。比较2组手术时间、术中出血量,以及术后下床活动时间、肛门恢复排气时间、疼痛视觉模拟(VAS)评分、并发症发生率和住院时间。结果 2组均成功完成手术,手术时间差异无统计学意义(P0.05)。腔镜组手术时间、术中出血量,以及术后下床活动时间、肛门恢复排气时间、VAS评分、并发症发生率和住院时间等,均优于开腹组患者,差异有统计学意义(P0.05)。结论对根部坏疽穿孔性阑尾炎患者实施LA是安全、可行的,其效果优于开腹阑尾切除术。但仍需严格掌握手术指征和规范进行手术操作。     

腹腔镜与开放手术治疗急性穿孔性阑尾炎的对比研究

目的:探讨腹腔镜手术治疗急性穿孔性阑尾炎的手术效果及临床价值。方法:回顾分析2010年9月至2015年9月收治的253例穿孔性阑尾炎患者的临床资料,其中115例行腹腔镜阑尾切除术(laparoscopic appendectomy,LA),为LA组;138例行开腹阑尾切除术(open appendectomy,OA),为OA组,对比两组手术时间、肠道功能恢复时间、住院时间、切口感染率、腹腔脓肿发生率。结果:两组均无围手术期死亡病例,均无粪漏发生。LA组较OA组手术时间短[(59.07±11.38)min vs.(79.24±13.84)min,P0.001];肠功能恢复快[(16.77±2.49)h vs.(23.72±3.69)h,P0.001];住院时间短[(5.78±0.98)d vs.(7.24±1.17)d,P0.001],切口感染发生率低(2/115 vs.15/138,P=0.004),术后腹腔脓肿发生率两组差异无统计学意义(6/115 vs.5/138,P=0.536)。结论:LA治疗急性穿孔性阑尾炎较传统手术方式具有明显优势,具有临床推广价值。     

腹腔镜手术治疗复杂性阑尾炎

目的 总结腹腔镜手术治疗复杂性阑尾炎的经验.方法 2008年2月～ 2012年2月对87例复杂性阑尾炎(坏疽、穿孔性阑尾炎或阑尾周围脓肿形成)行腹腔镜手术,术式包括腹腔镜阑尾切除联合腹腔冲洗引流,腹腔镜下阑尾脓肿清创引流术.结果 无死亡病例,3例中转开腹,4例阑尾周围脓肿形成需要行二期阑尾切除术.手术时间(54±21) min,术后肛门排气时间(38±13)h,术后住院时间(5.0±1.4)d.术后6例出现并发症,其中戳孔感染3例,切口换药后愈合;腹腔残余脓肿2例,抗炎治疗后脓肿逐渐吸收;粪漏1例,经过肠外营养支持、充分引流及使用抗生素后愈合.80例随访8～44个月,平均14个月,2例出现粘连性肠梗阻,余无其他并发症出现.结论 腹腔镜手术治疗复杂性阑尾炎是安全有效的.     

开腹和腹腔镜阑尾切除术治疗妊娠期急性阑尾炎的对照研究

目的 比较开腹阑尾切除术（open appendectomy,OA）和腹腔镜阑尾切除术（laparoscopic appendectomy,LA）治疗妊娠期急性阑尾炎的安全性及疗效.方法 回顾性分析我院2008年1月至2013年1月收治的68例妊娠早、中期急性阑尾炎的临床资料,其中OA组36例,LA组32例,并进行比对分析.结果 两组病例手术均顺利完成,OA组和LA组在妊娠相关并发症发生率上无明显差异（P＞0.05）;而在术后肛门排气时间、住院时间及术后并发症上,LA组均明显优于OA组,差异有统计学意义（P＜0.05）.结论 LA治疗妊娠早、中期急性阑尾炎是安全可行的,具有创伤小、术后恢复快、并发症少等优点.     

Laparoscopic Appendectomy for Appendiceal Endometriosis Presenting as Acute Appendicitis: Report of a Case

Endometriosis is a relatively common disorder in women of reproductive age; however, appendiceal endometriosis is rare. Thus, a definitive diagnosis is likely to be established only by histology of the appendix. We report a case of endometriosis of the appendix in a 42-year-old woman who presented with symptoms of acute appendicitis. We treated the patient by performing laparoscopic appendectomy, which resulted in a good outcome.     

A Comparison of Laparoscopic and Open Appendectomy

Background and Objectives:

To compare laparoscopic appendectomy with traditional open appendectomy.

Methods:

Seventy-one patients requiring operative intervention for suspected acute appendicitis were prospectively compared. Thirty-seven patients underwent laparoscopic appendectomy, and 34 had open appendectomy through a right lower quadrant incision. Length of surgery, postoperative morbidity and length of postoperative stay (LOS) were recorded. Both groups were similar with regard to age, gender, height, weight, fever, leukocytosis, and incidence of normal vs. gangrenous or perforated appendix.

Results:

Mean LOS was significantly shorter for patients with acute suppurative appendicitis who underwent laparoscopic appendectomy (2.5 days vs. 4.0 days, p<0.01). Mean LOS was no different when patients classified as having gangrenous or perforated appendicitis were included in the analysis (3.7 days vs. 4.1 days, P=0.11). The laparoscopy group had significantly longer surgery times (72 min vs. 58 min, p<0.001). There was no significant difference in the incidence of postoperative morbidity.

Conclusions:

Laparoscopic appendectomy reduces LOS as compared with the traditional open technique in patients with acute suppurative appendicitis. The longer operative time for the laparoscopic approach in our study is likely related to the learning curve associated with the procedure and did not increase morbidity.     

Residual Appendicitis Following Incomplete Laparoscopic Appendectomy

Growing popularity of laparoscopic interventions must bring along a thorough knowledge of possible complications inherent to the laparoscopic technique. With these two cases of residual appendicitis following incomplete appendectomy, the authors want to warn for this complication. Surgeons should be aware of residual appendicitis as a possible cause of acute abdomen at any time following a laparoscopic appendectomy.     

腹腔镜手术治疗急性阑尾炎72例报告

目的探讨腹腔镜手术治疗急性阑尾炎的价值. 方法对54例急性化脓性阑尾炎、18例阑尾炎穿孔并腹膜炎行腹腔镜手术治疗,并与同期72例阑尾炎开放手术比较. 结果腹腔镜组的并发症发生率、肠功能恢复时间及平均住院日分别为0,0.5 d,2.3 d,对照组分别为15%,2.5 d,6.8 d,两组比较有显著差异. 结论与开放手术比较,腹腔镜治疗急性化脓性阑尾炎及阑尾穿孔性腹膜炎有并发症少,术后恢复快的优势.     

Laparoscopic Appendectomy for Perforated Appendicitis

Although laparoscopic appendectomy for uncomplicated appendicitis is feasible and safe, its application to perforated appendicitis is uncertain. A retrospective study of all patients with perforated appendicitis from 1992 to 1999 in a university hospital was performed. A series of 231 patients were diagnosed as having perforated appendicitis. Of these patients, 85 underwent laparoscopy (LA), among whom 40 (47%) required conversion to an open procedure. An open appendectomy (OA) was performed in 146 patients. The operating time was similar for the two groups. Return of fluid and solid diet intake were faster in LA than OA patients (p <0.01). Postoperative infections including wound infections and abdominal abscesses occurred in 14% of patients in the laparoscopy group and in 26% of those with OA (p < 0.05). The surgeon’s experience correlated with the conversion rate. Laparoscopic appendectomy is associated with a high conversion rate for perforated appendicitis. If successful, it offers patients faster recovery and less risk of infectious complications.     

Perforated Appendicitis: Is Laparoscopy Safe?

OBJECTIVE: The purpose of this study was to demonstrate the safety and efficacy of laparoscopy in children with perforated appendicitis. METHODS: This is a retrospective review of consecutive patients under the age of 18, operated on for perforated appendicitis between September 1997 and December 1999. RESULTS: Sixty-nine patients were operated on for perforated appendicitis. Eleven appendectomies were performed laparoscopically. Fifty-four patients underwent an open appendectomy. Four laparoscopic appendectomies were converted to an open procedure. The mean operative time was 79 minutes for the laparoscopic group, and 87 minutes for the open group. The mean length of hospital stay was 5.4 days versus 7.6 days for the laparoscopic and open groups, respectively. Neither of these differences was statistically significant. CONCLUSIONS: The above data support the use of laparoscopy in the management of perforated appendicitis in children. In conclusion, laparoscopy is as safe as open appendectomy. Laparoscopy is an effective alternative with a shorter length of hospital stay compared with that for an open appendectomy for perforated appendicitis in children.     

金黄膏对急性阑尾炎腹腔镜阑尾切除术后胃肠功能的影响

目的:探讨金黄膏对急性阑尾炎腹腔镜阑尾切除术后胃肠功能和炎性因子的影响。方法:选择2018年8月—2020年7月本院收治的150例急性阑尾炎患者,随机分为对照组和观察组,各75例。对照组常规行腹腔镜阑尾切除术,观察组在腹腔镜术后加用金黄膏外敷。比较两组临床疗效、胃肠功能、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白CRP)、白细胞计数、中性粒细胞水平及并发症发生情况。结果:治疗后,观察组临床总有效率(85.33%)高于对照组(62.67%),差异有统计学意义(P<0.05);观察组GSRS评分、首次排气时间及肠鸣音恢复时间分别为(6.74±1.85)分、(23.49±6.30)h、(19.33±4.71)h,均低于对照组的(9.08±2.47)分、(30.08±7.22)h、(27.59±5.63)h,差异有统计学意义(P<0.05);两组TNF-α、IL-6、CRP、白细胞计数及中性粒细胞水平均低于治疗前(P<0.05),且观察组TNF-α、IL-6、CRP、白细胞计数及中性粒细胞水平分别为(37.53±6.12)pg/mL、(29.74±4.99)pg/mL、(7.88±2.19)mg/L、(7.69±0.97)×109 /L、(58.27±3.10)%,低于对照组的(56.49±8.51)pg/mL、(40.05±6.11)pg/mL、(12.07±2.63)mg/L、(10.87±1.53)×109 /L、(74.69±3.55)%,差异有统计学意义(P<0.05);观察组疼痛、肠梗阻、切口感染、腹腔脓肿等并发症发生率(6.67%)低于对照组(20.00%),差异有统计学意义(P<0.05)。结论:金黄膏用于急性阑尾炎腹腔镜阑尾切除术后患者,可改善患者临床疗效,促进患者胃肠功能的恢复,降低其炎性因子水平,且并发症发生率低,具有临床推广意义。     

Laparoscopic Appendectomy for Complicated Appendicitis: A Comparison with Open Appendectomy

Background  Although laparoscopic appendectomy (LA) is widely performed in many countries, LA for complicated appendicitis, which includes perforated or gangrenous appendicitis with or without localized or disseminated peritonitis, has not become a common practice yet. Methods  We retrospectively analyzed the clinical records of 230 patients who had undergone appendectomy for complicated appendicitis: 141 had undergone LA, 84 had conventional open appendectomy (OA), and 5 patients had conversion to the open procedure after laparoscopy. The LA group (total LA) was subdivided into “early experience (early LA: cases 1–56)” and “late experience (late LA: case 57 and higher).” We defined the early LA group as the comparison group to minimize selection bias. Results  Patient demographics were similar in the early LA and OA groups (P > 0.05). Wound infection was significantly more frequent in the OA group (P < 0.05). Intra-abdominal infection was equally common in these two groups. The overall rate of postoperative complications was significantly higher in the OA group (32.1%) than in the early LA group (18%; P < 0.05). This incidence was 12.8% in the total LA group. Hospital stay was significantly shorter in the early LA group (10.6 ± 3.9 days; P < 0.05), and 8.9 ± 3.7 days in the total LA group. Conclusions  Our findings indicate that LA is safe and useful even for the treatment of complicated appendicitis if performed by an experienced surgeon.     

Current management of appendicitis at a community center--how can we improve?

BACKGROUND: Controversies regarding the diagnosis and treatment of appendicitis remain. Practices and outcomes at a community center including imaging, timing of surgery, and surgical technique are reported. METHODS: From January to July 2006, 134 patients undergoing appendectomy in Victoria, British Columbia, were reviewed. Accuracy of preoperative imaging, time from the emergency room to the operating room, length of stay, and early complications were analyzed. Patients with and without perforation were compared using sample t tests. RESULTS: Preoperative computed tomography was obtained for 101 patients (75%) with a negative appendectomy rate of 3% versus 10% for patients without imaging. Imaging did not prolong the time to surgery (11.8 vs 10.9 h, P = .48). Patients with perforation stayed in the hospital significantly longer and had more complications. CONCLUSIONS: The liberal use of computed tomography resulted in fewer negative appendectomies without a significant delay to surgery. Patients with perforation had increased complications and longer hospitalizations. Efforts should be made to identify and treat early appendicitis.