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。     

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。     

悬吊式无气腹腹腔镜阑尾切除术在高龄患者中的应用

目的:总结悬吊式无气腹腹腔镜阑尾切除术在高龄患者中的应用经验。方法:对42例急性阑尾炎的高龄患者(年龄≥70岁)行无气腹腹腔镜下阑尾切除术治疗,建立低压短暂气腹并确定阑尾位置,在阑尾处腹壁用带线缝合针(双针荷包线)以5 cm间距垂直刺入腹腔,从0.5 cm trocar将双针拖出,关闭气腹,剪断双针打结后将腹外缝合线提起,固定在支架上,形成操作空间,按常规腹腔镜阑尾切除术操作。结果:42例患者中,41例经悬吊式无气腹腹腔镜切除获得成功,1例浆膜下阑尾,镜下切除失败,中转开腹。手术时间25~52 min,平均32.2 min。术中出血5~20 m L,平均8 m L。术后住院时间2~8 d,平均3.6 d。比较短暂气腹(气腹压力设定在6 mm Hg(1 mm Hg=0.133 k Pa),时间在2 min之内)前后的血压、心率、氧饱和度、动脉血气,无明显变化。全组无术后出血、肠瘘、粘连性肠梗阻、腹腔脓肿等并发症。结论:悬吊式无气腹腹腔镜阑尾切除术手术时间短、平均出血量少、术后恢复快,对高龄患者是安全可靠的。     

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。     

腹腔镜阑尾切除术操作技巧探讨(附240例报告)

目的:探讨腹腔镜阑尾切除术(LA)的操作技巧。方法:LA术两操作孔均置于下腹部正中线上,阑尾动脉电凝止血,阑尾系膜电凝切开,阑尾残端结扎不包埋,电凝烧灼。结果:240例中,236例顺利切除阑尾,中转开腹4例。平均手术时间27m in。术后粘连性肠梗阻1例,腹腔内出血1例。无远期并发症。结论:作者所述LA安全可靠,操作简便。     

儿童阑尾穿孔的腹腔镜阑尾切除术

目的 :探讨儿童阑尾穿孔腹膜炎行腹腔镜阑尾切除术的优缺点。方法 :分析 30例阑尾穿孔并腹膜炎手术治疗患儿的临床资料 ,其中 15例行LA为腹腔镜组 ,15例开腹阑尾切除术为对照组。比较两组病例的手术时间、术后引流时间、住院时间、术后并发切口感染及腹腔残余感染等情况。结果 :15例LA手术时间 30～ 75min ,平均 5 2min ,几乎无出血 ,术中冲洗并吸尽腹腔内脓液后留置腹腔引流 2～ 3d ;切口感染 1例 ,平均住院 7d。对照组 15例手术时间 4 5～ 110min ,平均 6 4min ,腹腔残余感染 3例 ,切口感染 2例 ,肠粘连 1例。结论 :阑尾穿孔并腹膜炎患儿行LA比常规开腹术恢复快 ,住院时间短 ,切口感染及腹腔残余感染发生率明显降低 ,且切口疤痕小 ,美容效果好。阑尾脓肿形成早期不是LA的禁忌证 ,但阑尾脓肿并广泛包裹者不宜行LA。     

免气腹单孔腹腔镜阑尾切除69例

目的评价免气腹单孔腹腔镜阑尾切除术的可行性和效果。方法 2008年8月～2009年10月,对69例急性阑尾炎行免气腹单孔腹腔镜阑尾切除术。在硬膜外麻醉下,在右下腹麦氏点处做1.5～1.8 cm的切口,用免气腹悬吊装置,提起右下腹壁,建立腹腔镜操作空间。阑尾切除的方法有以下3种:完全腹腔外切除阑尾;腹腔内先游离阑尾,然后再在腹腔外切除阑尾;在腹腔内完成阑尾切除术所有的操作。如果有局限性腹膜炎,或阑尾残端炎症严重或残端处理不满意,则在右下腹放置引流管,并从切口处引出。结果 3例需要延长切口完成手术。免气腹单孔腹腔镜阑尾切除术成功66例,平均手术时间51 min(38～72 min),术中出血10 ml,无邻近肠管损伤。手术后24 h内均能下床活动。术后1例局限腹腔感染,1例切口感染,无腹腔出血。2例均经保守治疗痊愈。结论免气腹单孔腹腔镜阑尾切除术是一种安全可行的方法。     

悬吊式免气腹经脐单孔腹腔镜阑尾切除术的临床分析

目的:探讨悬吊式免气腹经脐单孔腹腔镜阑尾切除术的可行性及临床应用价值。方法:回顾分析2013年8月至2014年5月为20例患者行悬吊式免气腹经脐单孔腹腔镜阑尾切除术的临床资料,术中使用骨科牵引弓、克氏针自制腹壁悬吊装置及普通腹腔镜操作器械完成手术。结果:手术均获成功,无中转常规腹腔镜手术及开腹手术,手术过程顺利,手术时间40~70 min,平均(54.0±1.7)min;无腹腔、脐部切口感染,平均住院(6.0±1.2)d,患者均顺利出院。结论:悬吊式免气腹经脐单孔腹腔镜阑尾切除术具有微创及美容的优势,使用普通腹腔镜操作器械也可完成手术,具有临床推广价值。     

阑尾腹壁悬吊在腹腔镜阑尾切除术中的应用

目的探讨阑尾腹壁悬吊行三孔法腹腔镜阑尾切除术的可行性及临床意义。方法2003年3月～2006年1月，168例阑尾炎行阑尾腹壁悬吊三孔法腹腔镜阑尾切除术，其中急性阑尾炎156例，慢性阑尾炎12例。镜下找到阑尾后，于其根部系膜无血管区戳孔并扩大，对应腹壁体表投影点刺人带有7号丝线的大三角针，穿出三角针将7号丝线的一段留置腹腔内，引过系膜戳孔于阑尾根部拟结扎点远端0．8～1.0cm处结扎阑尾，腹壁外提拉丝线完成阑尾悬吊。通过观察孔trocar套管内分离钳送出的悬吊线取出阑尾标本。结果腹腔镜下完成阑尾切除165例，手术时间32～95min，平均48min。中转开腹3例，其中2例网膜、肠管致密粘连形成炎性包块，1例子宫内膜异位症术后粘连致阑尾无法显露。无术后出血、腹腔脓肿、阑尾残端漏、肠管损伤及穿刺孔感染等并发症，均痊愈出院。132例随访3—36个月，平均16个月，无穿刺孔疝、阑尾残株炎、粘连性肠梗阻及慢性窦道形成。结论阑尾腹壁悬吊三孔法腹腔镜阑尾切除术操作简便可行，改善了术野显露，降低镜下精细操作难度，有利于腹腔镜技术在基层医院推广。     

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。     

无钛夹腔内打结法腹腔镜阑尾切除的临床研究

目的 :探讨腔内打结技术在无钛夹腹腔镜阑尾切除术中的效果。方法 :应用腹腔镜腔内打结术行三孔法腹腔镜阑尾切除术 38例。于阑尾系膜根部紧贴阑尾壁戳孔分离系膜 ,穿过 7号丝线结扎阑尾系膜 ,沿阑尾缘电凝至根部 ,双重结扎切除阑尾。结果 :患者均于腹腔镜下行阑尾切除术 ,无中转开腹 ,手术平均时间 4 2min ,平均住院 4d。结论 :无钛夹腔内打结法腹腔镜阑尾切除术具有患者创伤小 ,康复快 ,安全可靠 ,手术费用低 ,消除因钛夹留置体内对患者心理及磁共振等检查不利影响的特点     

阑尾穿孔腹腔镜阑尾切除术41例临床分析

目的：总结腹腔镜阑尾切除术治疗阑尾穿孔并腹膜炎的效果。方法：分析41例患者阑尾穿孔并腹膜炎行腹腔镜手术的临床资料,并随机选择常规开腹手术40例为对照组,比较两组的手术时间、术后切口感染、腹腔残余感染及肠粘连等并发症的发生率。结果：腹腔镜组手术时间45～95min,平均61min,几乎无出血,术后穿刺口感染1例,肠间积液1例,无近期肠粘连等并发症。对照组40例手术时间50～110min,平均58min,腹腔残余感染8例,切口感染7例,近期肠粘连4例。结论：腹腔镜阑尾切除术是阑尾穿孔并腹膜炎的首选治疗方式,具有开腹手术无法比拟的优点,可明显降低切口感染、腹腔残余感染及肠粘连等并发症。取出阑尾时尽量不与穿刺口接触及术毕彻底冲洗腹腔是避免以上并发症的关键。     

LAPAROSCOPIC APPENDECTOMY IN PAEDIATRIC PATIENTS: OPTIMIZATION WITH A NEW METHOD OF PORT INSERTION

Background : Conventional methods of port insertion for laparoscopic appendectomy often result in poor surgical access, especially when a pelvic appendix is encountered or when mobilization of the caecum becomes necessary. The relatively small antero-posterior diameter of the peritoneal cavity in children further aggravates this problem. Methods : We have modified the procedure by inserting only one 10-mm port at the sub-umbilical position, and two 5-mm ports at the lower abdomen beneath the ‘bikini line’. The videoscope is inserted via the left lower abdominal port, and the sub-umbilical port and the right lower abdominal port are used as the working ports. Results : Very satisfactory results have been achieved. The bottom of the caecum can be well visualized and caecum mobilization becomes easy. A pelvic appendix is well visualized. Dissection of a high retrocaecal appendix could be carried out without being obscured by the caecum. Better cosmetic results were also achieved. The method has been applied in 66 patients (aged 4–14). The mean operation time was 62 min. Conclusion : We recommend this approach to be used as the standard procedure for laparoscopic appendectomy in children.     

Is Laparoscopic Appendectomy an Effective Procedure ?

Aim: To compare the results of open and laparoscopic appendectomy and to determine if the laparoscopic approach might be more effective for some subgroups of patients.

Material and methods: We retrospectively analysed the computerised data of 326 consecutive adult patients operated on for suspected appendicitis between 2001 and 2005. The series consisted of 166 men and 160 women with a mean age of 32 ± 16 years and a mean Body Mass Index (BMI) of 24 ± 4. There were 265 ASA I, 46 ASA II and 5 ASA III patients. According to the surgeon’s preference, 176 patients had an open appendectomy (OA) and 150 a laparoscopic appendectomy (LA).

Results: The mean operative time and hospital stay were equivalent in the two groups: respectively 49 ± 19 min. and 4.1 ± 2.5 days in OA and 50 ± 16 min. and 3.5 ± 1.8 days in LA. However, subgroup analysis revealed that overweight (BMI > 25) patients (n=102) and patients with ectopic appendices (n=86) had an obvious benefit from LA. In cases of OA, operative time and hospital stay were longer in overweight patients than in normal weight patients: respectively 63 ± 20 min. and 5.3 ± 2.9 days versus 44 ± 16 min. (p < 0.01) and 3.7 ± 2.2 days (p < 0.01). On the contrary, no difference was observed in the lA group. Operative time and hospital stay were also longer in patients with ectopic appendices submitted to OA than in patients with an appendix in the normal position: respectively 60 ± 18 min. and 4.7 ± 2.7 days versus 45 ± 18 min. (p < 0.01) and 3.9 ± 2.4 days (p < 0.01). Again, such a difference was not observed in cases of LA. We noted no mortality, but 24 patients (7%) developed an abdominal complication: 18 wound infections and 6 intra-abdominal abscesses. Wound infections were more common in the OA than in the LA group: 7.3% (13/176) versus 3.3% (5/150) (p = 0.1). In the LA group, 4 wound infections were observed in our early experience, at a time where no endoscopic bag was used for the removal of the appendix. The rate of intra-abdominal abscesses was similar: 1.7% (3/176) in the OA group and 2% (3/150) in the LA group.

Conclusions: LA is an effective procedure with a reduced risk of developing wound infection. The laparoscopic approach is particularly effective for overweight patients and/or patients with ectopic appendices as far as shortening the operative time and hospital stay are concerned.     

经脐单孔腹腔镜胆囊阑尾联合切除术16例报告

目的探讨经脐单孔腹腔镜胆囊阑尾联合切除术的临床应用价值。方法回顾性分析我院2010年7月～2012年1月16例经脐单孔腹腔镜胆囊阑尾联合切除术的临床资料。经脐置入多孔道trocar,曲线形腹腔镜器械先切除胆囊并使用推结器丝线打结结扎胆囊动脉及胆囊管,然后行阑尾切除,4例由脐孔行拖出式阑尾切除,12例应用常规腹腔镜器械切除阑尾并使用推结器丝线打结结扎阑尾动脉及阑尾根部。结果 16例均获成功,未放置引流。手术时间60～150 min,平均80.4 min,无并发症发生。结论使用专用器械行经脐单孔腹腔镜胆囊阑尾联合切除术安全、可行,但较传统腹腔镜手术操作困难,需要有一个学习曲线。     

Laparoscopic Appendectomy with the Help of a Wire Snare

This report describes the performance of a laparoscopic appendectomy (LA), a new technique using a "wire snare" without any specific complications. The snare consisted of an 18-gauge injection needle and folded fine wire, measuring 0.28 mm in diameter. LA was performed in 95 patients with acute appendicitis using a cheap and simple wire snare to catch the ligation thread of #0 silk. A good view of the appendix and mesoappendix was obtained in all cases by traction of the #0 silk. The operative time needed to perform LA using a wire snare for nongangrenous appendicitis in 77 cases overall, the first 10 cases, and the last 10 cases was 54 ± 17, 64 ± 5, and 33 ± 4 min, respectively. Two of the 95 patients required conversion to an open appendectomy because of technical difficulties due to the formation of an inflammatory mass. There were no complications associated with insertion of the snare. The wire snare is an innovative technique and does not increase the costs significantly, and should help reduce the number of trocar sites and the operative time, while also making an LA easier to perform. Received: July 31, 2000 / Accepted: January 9, 2001     

腹腔镜阑尾切除术700例分析

目的：总结腹腔镜阑尾切除术（1aparoseopic appendectomy,LA）的治疗经验。方法：回顾分析1998年8月至2008年4月经腹腔镜治疗的700例阑尾炎患者的临床资料。结果：中转开腹4例（肠系膜淋巴瘤1例,阑尾周围粘连解剖不清3例）。手术时间20—85min,平均32min。术后6～12h下床活动,住院2～6d,平均3d,切口感染3例,术后随访1—10年,平均4．5年,无粘连性肠梗阻及切口疝发生。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。