腹腔镜在慢性阑尾炎诊治中的应用价值(附296例报告)

目的:比较腹腔镜手术与开腹手术在慢性阑尾炎治疗中的应用价值。方法:回顾分析2000年1月至2008年12月我院施行296例慢性阑尾炎手术的临床资料,164例行开腹手术,132例行腹腔镜手术,对比两组手术时间、术中出血、住院时间、术中发现和处理情况,并随访患者术后慢性腹痛的改善情况。结果:手术时间开腹组(52.76±21.82)m in,腹腔镜组(49.78±18.01)m in,t=0.88,P>0.05;术中出血开腹组(16.60±8.28)m l,腹腔镜组(9.68±4.22)m l,t=3.48,P<0.05;住院时间开腹组(7.84±3.27)d,腹腔镜组(6.80±2.98)d,t=2.98,P<0.05。腹腔镜组30例(22.7%)术中发现不同程度的腹腔粘连,阑尾与周围粘连10例,回盲部与前侧腹壁粘连8例,大网膜与腹壁及肠管粘连6例,升结肠与周围及腹腔内其他粘连6例,均在术中给予松解;开腹组18例(11.0%)术中发现阑尾与周围粘连,松解粘连行阑尾切除术,两组比较χ2=8.06,P<0.05;成功随访122例开腹手术者术后26例(21.3%)仍有慢性腹痛,98例腹腔镜手术者术后10例(10.2%)仍有慢性腹痛,两组比较χ2=6.68,P<0.05。结论:腹腔镜对慢性阑尾炎的诊治有一定的优势。     

开腹手术和腹腔镜阑尾炎切除术治疗急性阑尾炎疗效比较

目的比较开腹手术与腹腔镜阑尾炎切除术的效果。方法将2010-12—2014-01间80例阑尾炎患者按自愿原则分为治疗组和对照组2组,每组40例,治疗组实施腹腔镜阑尾炎切除手术,对照组患者采用传统开腹阑尾切除术,比较2组患者治疗效果。结果治疗组手术时间、住院时间、术中出血量、术后切口感染发生率、进食时间均低于对照组,2组比较差异有统计学意义(P<0.05)。结论腹腔镜阑尾炎切除手术创伤小,术后恢复快,效果满意。     

慢性阑尾炎腹腔镜与开腹阑尾切除术疗效观察

目的对比分析腹腔镜与开腹阑尾切除术治疗慢性阑尾炎的效果。方法随机将60例慢性阑尾炎患者分为对照组和实验组,每组30例。对照组采用开腹阑尾切除术,观察组采用腹腔镜阑尾切除术。观察并比较2组治疗效果。结果观察组术中出血量,术后下床活动时间,肛门排气时间和住院时间均明显短于对照组,(P0.05)差异有统计学意义。结论腹腔镜阑尾切除术治疗慢性阑尾炎,术中出血少,恢复时间短,疗效确切。     

急性阑尾炎行腹腔镜手术与传统开腹手术的比较

目的对比急性阑尾炎经腹腔镜切除与传统开腹切除的手术效果及优缺点。方法对2004年2月~2004年12月临床诊断为急性阑尾炎的病人123例,其中行腹腔镜手术59例,开腹手术64例。比较两种术式的手术时间,术后下床活动时间,术后进食时间,术后出院时间,止疼药使用率,其他器官探查阳性率及综合费用。结果通过比较两种术式的以上各指标,腹腔镜手术组有明显的优势。结论急性阑尾炎经腹腔镜手术具有创伤小、疼痛轻、恢复快、住院时间短及美容等优点,是治疗急性阑尾炎理想的手术方式。     

开腹手术与腹腔镜手术治疗阑尾炎的效果对比

目的分析开腹手术与腹腔镜手术治疗阑尾炎的临床疗效。方法将124例阑尾炎患者根据手术方式随机分为开腹组和腹腔镜组,每组62例。分别实施开腹和腹腔镜下阑尾切除术。观察并对比两组患者手术及并发症发生率等指标。结果 2组患者均顺利完成手术,腹腔镜组无中转开腹病例;两组患者手术时间、住院时间、术中出血量、术后排气时间、术后并发症等指标比较,腹腔镜组均优于开腹组,差异均有统计学意义(P<0.05)。结论与开腹手术比较,腹腔镜手术治疗阑尾炎创伤小,并发症少,疗效肯定。     

开腹手术与腹腔镜手术治疗阑尾炎的效果对比

目的对比开腹手术与腹腔镜手术治疗阑尾炎的临床效果。方法收集手术治疗的阑尾炎患者142例,其中采用传统开腹手术63例,腹腔镜手术79例。观察2组患者在手术时间、住院时间、切口感染率、术后排气时间、术后并发症、住院费用等方面的差异。结果腹腔镜手术组在手术时间、住院时间、切口感染率、术后排气时间、术后并发症、住院费用等方面明显优于开腹手术组。结论腹腔镜手术治疗阑尾炎的临床效果明显优于开腹手术,值得推广应用。     

腹腔镜手术在治疗慢性阑尾炎合并慢性胆囊炎中的优势

目的:探讨慢性阑尾炎合并慢性胆囊炎的手术治疗方法。方法:回顾分析74例慢性阑尾炎合并慢性胆囊炎患者资料,分为腹腔镜手术组(腹腔镜组)39例,开腹手术组(开腹组)35例,观察两组的临床疗效,包括手术时间、首次排气时间、首次排便时间、术后并发症的发生率以及术后住院时间。结果:腹腔镜组的观察指标均明显优于开腹组,两组的手术时间分别为(56±12)min和(92±11)min,首次排气时间为(21±10)h和(46±16)h,首次排便时间为(38±15)h和(72±18)h,腹腔镜组术后无切口感染,而开腹组术后切口感染发生率为14.3%,腹腔镜组术后住院时间为(4±1)d,开腹组为(9±3)d。结论:慢性阑尾炎合并慢性胆囊炎的腹腔镜治疗手术时间短、术后胃肠道功能恢复快、并发症少,效果明显优于传统开腹手术方法。     

腹腔镜与开腹手术治疗急性阑尾炎临床疗效比较

探讨腹腔镜阑尾切除术(LA)治疗急性阑尾炎的临床效果。回顾性分析148例手术治疗的急性阑尾炎患者临床资料。其中68例行LA(LA组),80例行开腹阑尾切除术(OA组),比较两组手术时间、术中出血量、术后止痛药使用情况、手术切口长度、术后排气时间、术后引流时间、切口感染发生情况、住院时间、住院费用等。两组手术时间差异无统计学意义(P>0.05),住院费用LA组高于OA组(P<0.05),其余指标LA组均优于OA组(P<0.05)。急性阑尾炎患者行LA治疗效果更好,但费用相对较高。     

穿孔性阑尾炎行腹腔镜与开腹手术治疗的疗效比较观察

目的探讨腹腔镜与开腹手术治疗穿孔性阑尾炎的效果,为临床选择合理治疗方案提供依据。方法将46例穿孔性阑尾炎患者,随机分为2组,各23例。A组采用腹腔镜治疗,B组采用开腹手术治疗。对比2组治疗效果及并发症发生情况。结果A组手术时间、术后首次排气时间、下床活动时间、疼痛评分、住院时间及并发症发生率均低于B组,差异有统计学意义(P0.05)。结论与开腹手术比较,应用腹腔镜手术治疗穿孔性阑尾炎,疗效满意且安全可靠。     

开腹手术及腹腔镜手术治疗阑尾炎的对比分析

目的探讨开腹手术及腹腔镜手术治疗阑尾炎的疗效对比。方法将160例阑尾炎患者随机分为开腹手术组和腹腔镜手术组,各80例。对比分析2组患者的治疗效果。结果腹腔镜手术组患者手术时间、术中出血量、术后下床活动时间、术后肛门排气时间等显著优于开腹手术组患者,差异有统计学意义(P<0.05)。结论腹腔镜手术治疗阑尾炎比开腹手术,具有并发症少、住院时间短、术后恢复快且创伤小等特点,有较高的临床推广和使用价值。     

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。     

Laparoscopic versus open appendectomy in acute appendicitis: A randomized prospective study

Background: Laparoscopic appendectomy is a safe and effective procedure, as both a diagnostic and therapeutic tool. It seems to be more effective than the corresponding open procedure. Aim of this study is to evaluate a group of patients randomly allocated either to laparoscopic appendectomy (LA) or to open appendectomy (OA). Methods: From January 1998 to December 2002, 252 consecutive and nonselected patients, 155 women and 97 men, were randomized either to LA or OA. Recorded data were operative time, postoperative length, of stay and complications. Results: Mean operative time was 45 min (range 30–120) for OA and 36 min (25–60) for LA, mean postoperative stay was 5.5 days (4–12) for OA and 3.4 days (2–8) for LA. Complication occurred in 20 patients (14.5%) for OA and in four patients (2.6%) for LA. Conclusion: We believe that LA is effective in any kind of clinical situation, with low traumatic impact and best comfort for the patient.     

Laparoscopic versus open appendectomy for perforated appendicitis

The role of laparoscopic appendectomy (LA) for perforated appendicitis is under investigation. A retrospective study was conducted to compare the outcomes of laparoscopic versus open appendectomy (OA) for perforated appendicitis. From January 2001 through December 2003, 229 patients with perforated appendicitis were treated at Far-Eastern Memorial Hospital. LA was successfully completed in 91 of 99 patients. OA was performed in 130 patients. Operation time was longer in the LA group (mean ± SD =96.1±43.1 vs. 67.8±32.2 minutes, P<0.01). Return of oral intake was faster in the LA group (3.2±2.4 vs. 5.0±7.0 days, P<0.01). The intravenous antibiotic usage period was shorter in the LA group (4.4±2.8 vs. 6.3±7.1 days, P<0.01). The postoperative wound infection rates were 15.2 % (LA group) and 30.7% (OA group). The overall infectious complication rates were 19% in the LA group and 37% in the OA group (P<0.01). Hospital stay days were shorter for the LA group (6.3±2.9 vs. 9.3±8.6 days, P<0.01). Our results indicated that laparoscopic appendectomy is a safe and effective procedure for treating patients with perforated appendicitis.     

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。     

Laparoscopic appendectomy for perforated appendicitis: a comparison with open appendectomy

Background The role of laparoscopic appendectomy for perforated appendicitis remains controversial. This study aimed to compare laparoscopic and open appendectomy outcomes for children with perforated appendicitis. Methods Over a 36-month period, 111 children with perforated appendicitis were analyzed in a retrospective review. These children were treated with either laparoscopic (n = 59) or open appendectomy. The primary outcome measures were operative time, length of hospital stay, time to adequate oral intake, wound infection, intraabdominal abscess formation, and bowel obstruction. Results The demographic data, presenting symptoms, preoperative laboratory values, and operative times (laparoscopic group, 61 ± 3 min; open group, 57 ± 3 were similar for the two groups (p = 0.3). The time to adequate oral intake was 104 ± 7 h for the laparoscopic group and 127 ± 12 h for the open group (p = 0.08). The hospitalization time was 189 ± 14 h for the laparoscopic group, as compared with 210 ± 15 h for the open group (p = 0.3). The wound infection rate was 6.8% for the laparoscopic group and 23% for the open group (p < 0.05). The wounds of another 29% of the patients were left open at the time of surgery. The postoperative intraabdominal abscess formation rate was 13.6% for the laparoscopic group and 15.4% for the open group. One patient in each group experienced bowel obstruction. Conclusions Laparoscopic appendectomy for the children with perforated appendicitis in this study was associated with a significant decrease in the rate of wound infection. Furthermore, on the average, the children who underwent laparoscopic appendectomy tolerated enteral feedings and were discharged from the hospital approximately 24 h earlier than those who had open appendectomy.     

Appendiceal diverticulum associated with chronic appendicitis

INTRODUCTION

Appendiceal diverticulosis is a rare entity, with a global incidence between 0.004% and 2.1% of all appendectomies. It has been related with an elevated risk of perforation in comparison to acute appendicitis, as well as an increased risk for synchronic appendicular cancer in 48% of the cases, and colonic cancer in 43%. The incidence of chronic appendicitis has been reported in 1.5% of all appendicitis cases.

PRESENTATION OF CASE

We present a 73-year-old female, with no relevant familial history, who presented due to a four-month-long oppressive, moderate pain in the lower right abdominal quadrant without irradiation or any other accompanying symptoms.

DISCUSSION

The documented incidence of appendiceal diverticula and chronic appendicitis by themselves is low; therefore the presence of both entities at the same time is extremely rare.

CONCLUSION

We present a case in which both diagnoses concurred in the same patient. The relevance of this case relies on the importance of the adequate knowledge of these pathologies, so we can approach them correctly. Although it does not represent an absolute surgical emergency, appendectomy represents the first therapeutic option.     

Laparoscopic treatment of two patients with omental infarction mimicking acute appendicitis.

BACKGROUND: Omental infarction is a rare entity that usually causes symptoms similar to those of appendicitis. Ultrasound or computerized tomography scan can diagnose omental infarction preoperatively. METHODS: We treated two patients with omental infarction by performing a laparoscopic omentectomy in each one. RESULTS: The pathology verified the operative diagnosis, and both patients were discharged home on the first postoperative day. CONCLUSION: Omental infarction can be accurately diagnosed and safely treated with laparoscopy. Key Words: Laparoscopy, Omental infarction, Acute abdominal pain.     

Laparoscopic versus open appendectomy for complicated appendicitis

BACKGROUND: Laparoscopic appendectomy has been widely practiced for uncomplicated appendicitis; various reports demonstrated its merits in assisting diagnosis, reducing postoperative pain, analgesic requirement, and incidence of wound infection. The role of laparoscopy in management of complicated appendicitis, ie, gangrenous, perforated appendicitis and appendiceal abscess, remains undefined. Currently, the choice of operative approach is mostly at the surgeons' discretion. A retrospective study was conducted in our institution to review the feasibility, safety, and efficacy of laparoscopic appendectomy for patients with complicated appendicitis. STUDY DESIGN: From January 1999 to January 2004, records of patients older than 14 years of age with diagnosis of appendicitis were retrieved from computer database for analysis. All patients underwent diagnostic laparoscopy to confirm diagnosis of complicated appendicitis, and patients subsequently underwent either laparoscopic or open appendectomies. Patients' demographics data and perioperative outcomes from the two groups were compared. RESULTS: During the study period, 1,133 patients with acute appendicitis underwent operations in our institution. Two hundred forty-four patients (21.5%) with complicated appendicitis were identified by laparoscopy, of which 175 underwent laparoscopic appendectomy (LA) and 69 had open appendectomy (OA). Both groups of patients were comparable in demographics. Mean operative time was 55 minutes for LA group and 70 minutes for the OA group (p<0.001). Mean hospital stay was 5 days and 6 days for LA and OA group respectively (p<0.001). There was one conversion patient (0.6%) in the LA group who suffered from wound infection, and there were seven (10%) wound infections in the OA group (p=0.001). There were 10 cases (5.7%) of intraabdominal collection in the LA group and 3 (4.3%) in the OA group (p=0.473). There was no mortality in the current series. CONCLUSIONS: Laparoscopic appendectomy for complicated appendicitis is feasible and safe. It is associated with a significantly shorter operative time, lower incidence of wound infection, and reduced length of hospital stay when compared with patients who had open appendectomy.