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。     

腹腔镜下应用超声刀阑尾切除术280例体会

目的:探讨超声刀在腹腔镜阑尾切除术(LA)中应用的可行性。方法:回顾性分析280例应用超声刀行阑尾切除术的临床资料。结果:除1例中转开腹外全部用超声刀完成阑尾切除,无需特殊耗材,无术后并发症。结论:用超声刀行LA术安全、便捷、明显提高手术效率。     

外科夹致阑尾炎术后右下腹脓肿并腹壁窦道形成1例

腹腔镜阑尾切除术（LA）后的阑尾残株炎、腹腔脓肿甚至腹壁窦道形成是LA少见的并发症之一，虽然导致这种并发症的因素很难确定，但与术中回盲部组织状况及阑尾根部的处理方式有关。术中阑尾根部的处理方式有缝合结扎、套结线结扎、外科夹夹闭等。我科收治1例LA后疑似因Hem-o-lok夹脱落致右下腹脓肿并腹壁窦道形成的患者，经再次使用腹腔镜下手术处理后痊愈，该临床现象较为少见。     

腹腔镜阑尾切除术80例体会

目的 探讨腹腔镜阑尾切除术（laparoscopic appendectomy,LA）的常见手术技巧.方法回顾分析我院近3年来80例阑尾炎患者行LA的临床资料.结果 76例在腹腔镜下顺利完成手术,4例中转开腹,其中阑尾周围脓肿1例,特殊位置阑尾1例,阑尾根部坏疽穿孔1例,系膜血管回缩引起大出血1例,手术时间35～130min,住院时间3～9d,1例戳孔感染经对症处理后痊愈,无术后出血、肠粘连等并发症发生.结论耐心、细致、熟练的腹腔镜外科技术是保证各种阑尾炎一期切除、减少并发症的关键.     

腹腔镜阑尾切除术4450例分析

目的总结腹腔镜阑尾切除术(laparoscopic appendectomy,LA)的临床应用价值。方法行腹腔镜阑尾切除术患者4450例。采用三孔法操作,阑尾系膜单极电凝,体外打结结扎阑尾根部,简易标本袋取出阑尾。结果 4413例成功完成LA,37例中转开腹,手术时间18~190分钟,平均(56.00±15.50)分钟;术中出血2~35 ml,平均(10.0±5.5)ml;术后住院1~12天,平均4.2天。术后切口感染10例,术后肠梗阻及术中肠道损伤各1例,无术后肠漏、残端瘘、腹腔脓肿、切口疝等手术并发症。结论 LA治疗阑尾炎安全、有效,创伤小,痛苦轻,术后住院时间短,康复快,并发症少。     

不同术式阑尾切除术后切口感染的对比分析一项大型多中心回顾性研究

目的 探讨腹腔镜阑尾切除手术(laparoscopic appendectomy,LA)后常见并发症切口感染的发生情况.方法 回顾性分析2011-2013年华东地区6家县市级医院所有急性阑尾炎手术患者的临床资料,对LA和开腹阑尾切除术(open appendectomy,OA)后的结果进行对比,并对所有阑尾切除术后导致切口感染的危险因素进行多因素回归分析.结果 9 340例患者中行LA阑尾切除术1 831例(19.6％),开腹阑尾切除术7 509例(80.4％);3年间LA手术开展的比例分别为9.2％、15.0％及32.9％.所有阑尾切除患者的术后切口感染并发症发生率为5.1％,其中LA为2.1％,OA为5.8％,两者差异有统计学意义(x2 =41.22,P＜0.01);3年间LA术后切口感染并发症发生率分别为5.6％、4.4％及3.5％,呈逐年下降趋势(x2=31.59,P＜0.01).多因素回归分析证实,不同手术方式是导致阑尾切除术后并发切口感染的一项独立影响因素(优势比1.37,95％可信区间1.12 ～1.63,P =0.02).结论 LA阑尾切除术后切口感染的发生率逐年下降,LA手术是阑尾切除术后并发切口感染的独立保护因素.     

腹腔镜阑尾切除术并发症探讨与分析

目的探讨腹腔镜阑尾切除术(LA)的并发症原因、预防与治疗。方法对648例阑尾炎患者行LA治疗,回顾分析患者的临床资料。结果术后发生并发症122例,发生率18.83%,包括穿刺孔及腹腔内出血、感染和炎性肠梗阻。化脓性、坏疽性阑尾炎、阑尾周围脓肿与慢性阑尾炎、急性单纯性阑尾炎相比并发症发生率明显增高,差异有统计学意义(P0.05)。结论阑尾病变程度与LA术后并发症发生率呈正相关。术前正确评估阑尾炎病变程度,严格掌握适应证,术中规范技术操作,适时中转开腹是预防LA并发症的关键。术后及早发现和综合治疗LA术后并发症效果良好。     

腹腔镜手术中腹腔冲洗引流的原则和方法

目的:探讨腹腔镜手术中腹腔冲洗引流的原则和方法。方法:总结腹腔镜胆囊切除术(LC)1 200例,腹腔镜阑尾切除术(LA)356例(肝脏功能异常和急性化脓性炎症病例除外),术中冲洗422例,引流101例的临床资料。结果:术后除2例延期拔管外,余均于术后1~2d拔管。未发生与腹腔冲洗引流有关的并发症。结论:准确掌握腹腔镜术中腹腔冲洗引流的原则和方法,可以缩短手术时间,术后加快患者恢复,减少手术并发症的发生。     

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。     

腹腔镜阑尾切除在基层医院治疗体会

目的探讨腹腔镜阑尾切除术(Laparoscopic appendectomy,LA)治疗阑尾炎的疗效。方法回顾2016年6月至2018年4月期间经腹腔镜治疗的299例阑尾炎患者的临床资料,统计分析患者的手术时间,术中出血量、术后下床活动时间、住院时间以及术后并发症等。结果 299例全部腹腔镜下完成阑尾切除,无中转开腹。患者的手术时间平均(45.31±10.09)分钟,术中出血量(16.24±4.17)ml,术后下床活动时间(10.31±2.17)小时,平均住院时间(4.53±1.12)天。术后6例发生并发症,2例切口感染,3例腹腔残余感染,1例发生术后切口疝。结论 LA具有创伤小,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,可在基层医院应用和推广。     

坏疽、化脓性阑尾炎合并穿孔的腹腔镜治疗

目的:探讨腹腔镜阑尾切除术(laparoscopic appendectomy,LA)治疗坏疽、化脓性阑尾炎合并穿孔的安全性和可行性。方法:总结2002年1月至2007年12月应用LA治疗93例坏疽、化脓性阑尾炎合并穿孔患者的临床资料,术中处理阑尾根部时,使用Endo-loop阑尾根部双重套扎或双重钛夹夹闭46例,直接腹腔镜下丝线打结阑尾根部23例,间断缝合阑尾残端加医用生物蛋白胶覆盖15例,清除阑尾残余组织加医用生物蛋白胶覆盖残端,放置硅胶引流管9例。结果:93例手术均获成功,无中转开腹,平均手术时间72min,术后排气时间22.5h,11例术后使用止痛药或止痛针,1例戳口感染,无肠漏及腹腔脓肿发生,平均住院5d。结论:随着腹腔镜技术的不断成熟、完善,对于坏疽、化脓性阑尾炎合并穿孔患者行LA是安全可行的,具有患者创伤小、痛苦轻、疤痕小、康复快、并发症少等优点。     

腹腔镜阑尾切除术中转开腹的原因及对策

目的：探讨腹腔镜阑尾切除术（laparoscopic appendectomy,LA）中转开腹的原因及对策。方法：回顾分析453例LA术中35例中转开腹患者的临床资料。结果：中转开腹的原因主要有：阑尾根部坏疽（20/35）,致密粘连或包裹（15/35）,阑尾位置过深（11/35）,术中大出血（4/35）等,合并2种或2种以上异常情况下中转率高达51.4%。结论：阑尾的炎症程度和位置是中转开腹的主要因素,术中遇有特殊情况、完成LA有困难时应及时主动中转开腹。     

Previously unreported high-grade complications of adrenalectomy

Background  Serious complications of adrenalectomy are rare but the incidence may be underestimated if they occur outside major referral centers. We report five cases of high-grade complications after adrenalectomy that have not been previously described. Methods  The records of five cases of adrenalectomy performed at outside hospitals were reviewed. Four cases were referred for management of complications and one for medical-legal review. The nature of the adrenal lesion, operative approach, complication(s), and subsequent clinical course and complication management were assessed. Both open adrenalectomy (OA) and laparoscopic adrenalectomy (LA) cases were included. Results  Operative indications were pheochromocytoma (N = 3), aldosteronoma (N = 1), and a nonfunctioning 6-cm hypervascular mass (N = 1). Complications of adrenalectomy included: case 1—complete transection of the porta hepatitis during right LA resulting in hepatic failure requiring emergent liver transplantation; case 2—ligation of the hepatic artery during right OA resulting in recurrent cholangitis and bile duct sclerosis requiring liver transplantation; case 3—ligation of the left ureter during LA resulting in postoperative hydronephrosis and loss of renal function; case 4—loss of left kidney function after OA, likely secondary to renal artery ligation ultimately requiring laparoscopic nephrectomy; case 5—LA of a normal adrenal gland for a 6-cm hypervascular mass thought to be arising from the adrenal gland. Three-month postoperative imaging demonstrated a persistent mass and the patient underwent hand-assisted laparoscopic nephrectomy for a left upper pole renal cell carcinoma that was missed at the time of LA. Conclusion  Despite the generally low morbidity of adrenalectomy, serious and potentially life-threatening complications can occur. Surgeon inexperience may be a factor in the occurrence of some of these complications which have not been previously described.     

阑尾炎再手术15例原因分析

目的分析阑尾炎再手术原因，探讨预防或减少阑尾炎手术后并发症的措施。方法回顾性分析15例阑尾切除术后再手术的临床资料。结果再手术的原因为漏诊结肠癌、阑尾恶性肿瘤5例，阑尾残株炎2例，Meckel憩室、回肠末端结核、阑尾动脉出血、盆腔脓肿、腹腔动脉卒中、盲肠瘘、粘连性肠梗阻、腹壁窦道形成各1例，予相应的再次手术治疗，除1例腹腔动脉卒中患者术后死于短肠综合征外，其余均痊愈出院。结论重视阑尾炎术前及术中的诊断及鉴别诊断，重视术中操作及术后并发症的处理，可减少或避免再手术的机会。     

腹腔镜多器官联合手术283例报告

目的:探讨腹腔镜多器官联合手术的优势。方法:回顾分析2006年9月至2011年10月为283例患者行腹腔镜多器官联合手术的临床资料,腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)联合胆总管取石T管引流术120例,LC联合肝组织活检术6例,LC+阑尾切除术(laparoscopic appendectomy,LA)66例,LC联合胃穿孔修补术5例,LC+子宫肌瘤切除术15例,LA+子宫肌瘤切除术2例,LC+卵巢囊肿剥除术22例,LA+卵巢囊肿剥除术4例,LC+肝囊肿开窗术8例,LA+肠粘连松解术6例,LC+肠粘连松解术28例,横结肠癌+直肠癌根治术1例。结果:2例中转开腹,余均顺利完成联合手术,术后1例发生切口感染。结论:只要严格把握手术治疗原则及联合手术适应证,腹腔镜联合处理多种腹部病变安全有效,具有患者创伤小、痛苦少、康复快、灵活方便、多病联治的优点。     

自体肝脏移植治疗晚期泡型肝包虫病

目的 探讨自体肝脏移植(liver autotransplantation,LA)治疗部分泡型肝包虫病的可行性及围手术期并发症的处理.方法 回顾分析2008年1月至2010年1月间6例行LA治疗泡型肝包虫病的病例资料.结果 全组除1例术后因门静脉血栓形成并发多脏器功能衰竭死亡外,余者均取得良好疗效.术后发生出血1例,胆...     

Emergency surgery after percutaneous transmitral commissurotomy: operative versus echocardiographic findings, mechanisms of complications, and outcomes

OBJECTIVE: This study was undertaken to determine the clinical profile of patients undergoing emergency surgery after balloon mitral valvotomy, to note operative findings and compare them with those of transthoracic echocardiography, to describe the mechanisms of complications, and to describe outcomes. METHODS: A retrospective study was undertaken of patients requiring emergency surgery after percutaneous mitral valvotomy with an Inoue balloon from January 1990 to December 2003. The data analyzed included demographic variables, causes and clinical presentations of complications, and outcome. In 14 consecutive cases of mitral regurgitation, an observational study comparing the operative findings with echocardiography was also undertaken. RESULTS: In 1388 cases of valvotomy, complications necessitating urgent surgery occurred in 31 cases (2.2%). Acute mitral regurgitation occurred in 23 cases (74.2%), and cardiac tamponade occurred in 8 cases (25.8%). Mitral regurgitation was due to leaflet tearing in all cases: anterior leaflet in 20 cases and posterior leaflet in 3 cases. Hypotension, orthopnea, and pulmonary edema were the clinical presentation for mitral regurgitation. Transthoracic echocardiography underestimated the severity of mitral valve pathology. Bilateral severe commissural fusion and pliable leaflet with paracommissural calcium was seen in anterior leaflet tearing. Cardiac tamponade with hemodynamic compromise occurred as a result of left atrial perforation in 6 cases, right atrial perforation in 1 case, and left ventricular perforation in 1 case. High septal puncture led to atrial perforation. Operative mortality was 9.6%, and low cardiac output developed in 29%. CONCLUSION: Acute mitral regurgitation and cardiac tamponade were the causes of emergency surgery after balloon valvotomy. Transthoracic echocardiography underestimated the severity of valve pathology.     

Stryker双极电凝钳在腹腔镜阑尾切除术中的临床应用

目的:探讨腹腔镜阑尾切除术(laparoscopic appendectomy,LA)中应用Stryker双极电凝钳的安全性和手术技巧。方法:回顾分析我院近2年为140例患者用Stryker双极电凝钳行LA的临床资料。结果:1例中转开腹,余均顺利完成腹腔镜手术。手术时间17~45min,平均32min;术中出血0~5ml。无术后出血、肠梗阻等并发症发生。结论:用Stryker双极电凝钳行LA安全可行,患者出血少,手术时间短,治疗费用低,可有效避免中转开腹。     

Safety of Laparoscopic Appendectomy During Pregnancy

Background  Use of laparoscopic appendectomy (LA) remains controversial during pregnancy because data regarding procedure safety are limited. The outcome of LA in pregnant women was evaluated and compared to results of open surgery. Methods  Between January 1997 and December 2007, 42 pregnant women (mean age 24 years [range: 19–40 years]; range of gestation: 5–25 weeks) underwent appendectomy for suspected acute appendicitis: 23 laparoscopic (LA) and 19 open appendectomies (OA). Retrospective review of medical charts included preoperative information, surgery results, and outcome of the pregnancy. Results  There was no difference between groups in surgery delay following arrival at the hospital. All procedures, except one case of Meckel’s diverticulitis, were completed laparoscopically without need for conversion. Acute appendicitis was found in 19 cases and Meckel’s diverticulitis in one case during LA (87%) and in 18 cases (95%) during OA. Complicated appendicitis was found in 7 (30%) pregnant women in the LA group and 1 (5%) in the OA group. Five women with normal preoperative abdominal ultrasonography had acute appendicitis (2 in the OA group and 3 in the LA group). The laparoscopic procedure was performed more often by senior surgeons (70% of cases), and OA was more commonly done by residents (47% of cases). There were no intraoperative or postoperative complications recorded. The length of postoperative hospital stay was slightly prolonged after LA—2.4 days versus 1.4 day after OA. There was one fetal loss in each group, 1 and 2 months after the operation. Conclusions  Laparoscopic appendectomy is safe and effective during pregnancy and is associated with good maternal and fetal outcome.     

腹腔镜联合手术的临床应用

目的：探讨腹腔镜联合手术的优越性和临床应用价值。方法：回顾分析2002年12月至2009年12月81例腹腔镜联合手术的临床资料,其中腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）＋腹腔镜阑尾切除术（laparoscopic appendec-tomy,LA）32例,LC＋腹腔镜胆总管探查术20例,LC＋肝囊肿开窗引流术6例,LC＋肠粘连松解术6例,LC＋卵巢囊肿或畸胎瘤切除术11例,LC＋筋膜内子宫切除术3例,LA＋卵巢囊肿切除术2例,完全腹膜外腹腔镜疝修补术＋精索静脉曲张高位结扎术1例。结果：81例腹腔镜联合手术均获成功,无中转开腹及手术并发症发生。结论：腹腔镜联合手术安全、有效,值得临床推广应用。