急性阑尾炎腹腔镜下阑尾切除术疗效观察

目的分析腹腔镜阑尾切除术治疗急性阑尾炎的临床疗效。方法将80例符合手术指征的急性阑尾炎患者随机分为对照组(行传统开腹手术)和腹腔镜组(腹腔镜阑尾切除术)两组,每组40例。比较两组平均手术时间、术后并发症、术后排气时间及住院时间。结果两组术后并发症、术后排气及住院时间差异有统计学意义(P0.05),平均手术时间差异无统计学意义(P0.05)。结论腹腔镜阑尾切除术治疗急性阑尾炎术后并发症发生率及住院时间均优于开腹手术。     

经脐单孔腹腔镜阑尾切除术治疗老年急性阑尾炎患者的效果分析

目的 探讨经脐单孔腹腔镜阑尾切除术(LA)治疗老年急性阑尾炎患者的安全性和效果。方法 回顾性分析2021-01—2021-11浚县人民医院行LA治疗的79例老年急性阑尾炎患者的临床资料。分为经脐单孔组(单孔组,37例)和常规三孔组(三孔组,42例)。比较2组患者的术中情况、术后临床指标。以数字评分法(NRS)评分评价患者术后6 h、24 h、48 h的疼痛程度。统计术后并发症发生率和患者的满意度。结果 2组手术时间、术中出血量和术后并发症发生率的差异均无统计学意义(P>0.05)。单孔组患者术后下地活动时间、肠鸣音恢复时间、肛门排气时间、恢复进食时间,以及住院时间均短于三孔组;术后6 h、24 h、48 h的NRS评分均低于三孔组,患者的满意度高于三孔组。差异均有统计学意义(P<0.05)。结论 经脐单孔LA的手术时间、术中出血量和术后并发症发生率与常规三孔LA的差异无统计学意义。但经脐单孔LA有利于促进老年急性阑尾炎患者术后胃肠功能恢复、减轻疼痛程度和提升患者的满意度。     

经脐单孔腹腔镜阑尾切除术在小儿外科的应用

目的:探讨施行经脐单孔腹腔镜阑尾切除术治疗小儿阑尾炎的安全性和可行性。方法:回顾分析18例急性阑尾炎患儿行经脐单孔腹腔镜阑尾切除术的临床资料。结果:18例手术均获成功,手术时间35～75min,平均42min。无脐孔感染及其他并发症发生,术后平均住院3.7d。结论:在严格掌握适应证的前提下,经脐单孔腹腔镜小儿阑尾切除术安全有效,且美容效果好。     

经脐单孔免钛夹腹腔镜阑尾切除术的临床分析

目的:探讨经脐单孔免钛夹腹腔镜阑尾切除术的可行性。方法:回顾分析为21例阑尾炎患者行经脐单孔免钛夹腹腔镜阑尾切除术的临床资料。结果:21例均顺利完成单孔手术,手术时间30~55min,平均38min。术后患者痛苦轻,康复快,腹壁无可见疤痕,无并发症发生。结论:选择好手术适应证,经脐单孔免钛夹腹腔镜阑尾切除术是可行的,且美容效果好。     

经脐单孔与经典腹腔镜保胆取石术的对比研究

目的:对比经脐单孔腹腔镜保胆取石术与经典腹腔镜保胆取石术的临床效果。方法:选择2011年7月至2014年6月拟行腹腔镜保胆取石术的患者92例,随机分为单孔腹腔镜组(单孔组,n=45)与三孔腹腔镜组(经典三孔组,n=47)。对比分析两组患者手术时间、术中出血量、并发症、术后疼痛评分、术后住院时间、总费用、患者满意度等指标。结果:两组术中出血量、并发症发生率、术后住院时间、总费用差异无统计学意义(P0.05)。两组手术时间、术后第1天疼痛视觉模拟评分、患者美容满意度差异均有统计学意义(P0.05)。结论:经脐单孔腹腔镜保胆取石术是安全、可行的,美容效果较好,可减轻患者的术后疼痛,但应在严格控制手术指征的前提下适度开展。     

经脐单孔与常规腹腔镜阑尾切除手术的比较研究

目的:探讨单孔腹腔镜阑尾切除手术的可行性。方法:对2011年1月—2011年12月收治的122例急性阑尾炎病例,按照随机原则分单孔腹腔镜组(61例)和常规腹腔镜组(61例),对两组的手术时间、术中出血量、肠道功能恢复时间、住院时间、并发症、中转率进行比较。结果:两组在术中出血量、术后肠道功能恢复时间、住院时间及术后并发症的比较,差异均无统计学意义(P>0.05),单孔腹腔镜组因粘连(2例)和腹膜后阑尾(1例)中转常规腹腔镜手术;坏疽性(穿孔性)阑尾炎的手术时间,单孔腹腔镜组明显长于常规腹腔镜组(P=0.004);单纯性阑尾炎和化脓性阑尾炎两组的手术时间无统计学差异(P>0.05)。结论:选择性对急性阑尾炎行单孔腹腔镜手术治疗是安全可行的;与常规腹腔镜比较,单孔腹腔镜治疗单纯性阑尾炎和化脓性阑尾炎同样具有恢复快、创伤小的优点,且比常规腹腔镜有更好的维护形体的效果。     

悬吊式经脐缘两孔法腹腔镜阑尾切除术效果分析

目的探讨急性单纯性阑尾炎采用悬吊式经脐缘两孔法腹腔镜阑尾切除术(LA)的效果。方法选取2016-11—2018-11间在汝州市人民医院接受LA的116例急性单纯性阑尾炎患者,将2016-11—2017-11间采用常规三孔法手术的患者作为对照组,将2017-12—2018-11间采用悬吊式经脐缘两孔法手术的患者作为观察组,各58例。比较2组疗效。结果 2组术中出血量差异无统计学意义(P0.05)。观察组术后恢复排气时间、VAS评分、住院时间及对切口满意度评分均优于对照组,差异有统计学意义(P0.05)。结论对急性单纯性阑尾炎患者实施悬吊式经脐缘两孔法LA,术后疼痛轻,胃肠功能恢复快,住院时间短,切口美观且效果好。     

经脐单孔腹腔镜与传统腹腔镜治疗妇科良性疾病的对比研究

目的通过经脐单孔腹腔镜与传统腹腔镜手术的对比研究,探讨经脐单孔腹腔镜手术在妇科良性疾病治疗中的应用价值。 方法2016年11月至2018年1月在中国航天科工集团七三一医院及河北医科大学第二医院妇科收治的80例妇科良性疾病的患者,根据手术方式分为经脐单孔腹腔镜手术组及传统腹腔镜手术组,每组40例,对两组的手术时间、术中出血量、中转开腹率、术后排气时间、疼痛评分、住院时间、并发症进行比较。 结果两组手术均成功,无中转开腹手术,随访至术后1年未发生并发症。两组的术中出血量、术后排气时间、住院时间相比,差异无统计学意义(P>0.05);单孔腹腔镜手术组的手术时间长于传统腹腔镜手术组[(111.00±54.90)min比(79.67±42.45)min],差异有统计学意义(P<0.05);但单孔腹腔镜手术组术后3 d疼痛的视觉模拟评分低于传统腹腔镜手术组[(2.6±0.92)分比(2.0±0.98)分],差异有统计学意义(P<0.05)。 结论经脐单孔腹腔镜手术微创、安全可行,相较于传统腹腔镜手术能够明显减轻术后疼痛。     

小儿免气腹单孔腹腔镜阑尾切除术与经脐单孔腹腔镜阑尾切除术的对比研究

目的:探讨免气腹单孔腹腔镜阑尾切除术的手术效果及方法。方法:将180例阑尾炎患儿随机分为两组,100例行免气腹单孔腹腔镜阑尾切除术(A组),80例行经脐单孔腹腔镜阑尾切除术(B组),对比两组手术时间、术后下床活动时间、术后胃肠功能恢复时间、术后住院时间及住院费用等指标。结果:180例手术均获成功。两组手术时间、住院费用差异无统计学意义(P>0.05),A组术后下床活动时间、术后胃肠功能恢复时间、术后住院时间显著短于B组(P<0.001)。结论:免气腹单孔腹腔镜阑尾切除术具有创伤更小、康复快、住院时间短、不增加费用等优点,是安全、有效的,在基层医院可推广应用。     

经脐单孔与传统多孔腹腔镜阑尾切除术对比的单中心回顾性研究

目的：回顾性比较分析经脐单孔与同期多孔法腹腔镜阑尾切除术患者的临床资料,探讨前者的安全性和可行性。方法：收集2009年1月—2011年5月行腹腔镜阑尾切除术患者53例。其中,单孔法组32例,三孔法组21例。对两组围手术期资料进行比较分析。结果：全部患者均顺利完成腹腔镜阑尾切除。两组患者在平均手术时间（P=0.358）和术中出血量（P=0.595）方面的比较无统计学差异;单孔组患者术后肠道功能恢复早于多孔组（1.2±0.4 d vs 1.5±0.5 d,P=0.029）。所有患者均于术后5 d内出院（3.8±0.8 d vs 4.0±0.9 d,P=0.462）。术后随访1个月~2年,两组患者并发症的发生率无统计学差异。结论：经脐单孔腹腔镜阑尾切除术安全、有效,美容效果好,具有可行性。其临床应用价值仍需进一步的临床研究证实。     

Single-incision laparoscopic appendectomy vs multiport laparoscopic appendectomy in children: a retrospective comparison

Background

Minimally invasive surgery is commonly used to treat appendicitis. Single-incision laparoscopic surgery is an attractive modality to treat a commonly occurring problem with the advantage of minimal or possibly no scarring. We sought to compare our results of single-incision laparoscopic appendectomy (SILA) with those of patients undergoing traditional multiport laparoscopic appendectomy (MPLA).

Patients and Methods

A retrospective review of all patients who underwent a minimally invasive appendectomy from September 2009 to February 2010 was performed. The patients were divided into 2 groups based on if they had a SILA or a traditional MPLA. Outcomes including demographics, diagnosis, operative time, length of stay, narcotic usage, and complications were evaluated.

Results

A total of 110 patients underwent appendectomy. There were 50 patients who underwent SILA and 46 patients who underwent MPLA. Fourteen patients with perforated appendicitis were excluded. Mean age (11.1 vs 11.7 years, P = .43), weight (43.3 vs 50.9 kg, P = .27), and length of stay (1.1 vs 1.2 days, P = .56) were comparable between both groups. Operative time for SILA was slightly longer (33.8 vs 26.8 minutes, P = .01). Overall intravenous narcotic use was lower in the SILA group (0.9 vs 1.4 doses, P = .01), but there was no difference in the patients who also received ketorolac (0.8 vs 1.0 doses, P = .6). Four patients in the SILA group developed superficial wound infections and 1 patient in the SILA group was admitted for postoperative abscess.

Conclusions

Single-incision laparoscopic appendectomy is safe and effective in the pediatric population. Further studies should be performed to determine the impact on operative time and postoperative narcotic requirements.     

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.     

Acute appendicitis: Standard treatment and the role of laparoscopic surgery

V. Conclusion M. W. Büchler, Bern. Acute Appendicitis: The Role of Laparoscopic Surgery. The conclusion at the end of the meeting by M. W. Büchler, Bern, was that the standard treatment for acute appendicitis remains the classic open technique described by McBurney in 1894. Only between 1% (United Kingdom) and 20% (USA) of all cases are removed laparoscopically. However, 12% of all surgical cases are performed for appendicitis and 40% of all small bowel obstructions are related to open appendectomy. The metaanalysis comparing laparoscopic versus open appendectomy showed that laparoscopic appendectomy is more expensive and takes longer, the complication rates are equal and there are no differences concerning pain, recovery and cosmesis. Despite the fact that laparoscopic appendectomy is a safe procedure, open appendectomy remains the standard procedure for clear diagnosis. However, the role of laparoscopic appendectomy in young females, obese patients and unclear diagnosis must be further evaluated.     

Comparison of Outcomes of Single-Incision Laparoscopic and Open Appendectomy in Management of Uncomplicated and Complicated Appendicitis

Several reports have demonstrated the effectiveness and feasibility of single-incision laparoscopic appendectomy (SILA). We have introduced SILA including transumbilical laparoscopic-assisted appendectomy (TULAA) and pure single-incision laparoscopic appendectomy (PSILA). A total of 124 patients underwent SILA for acute appendicitis in our department. Our consecutive experiences with SILA are reviewed, and its outcomes including medical treatment cost are compared to open appendectomy (OA). In the SILA group, the mean length of the operation was 65.0 min. Five patients required an additional port insertion, and three patients required open conversion. The postoperative hospital stay was significantly shorter (P < 0.01); an abdominal drain was placed in significantly fewer cases (P < 0.01). There were no significant differences in the total cost medical treatment with OA (P = 0.48). In patients with complicated appendicitis, the hospital stay was significantly shorter in SILA groups. There were no significant differences in all operative outcomes between TULAA and PSILA. SILA represents an expeditious and reliable technique for appendicitis especially in complicated cases. Further assessment including multicenter prospective study is thought to be required to confirm this.     

经脐单孔腹腔镜阑尾切除术联合加速康复外科治疗急性阑尾炎的可行性研究

目的 比较腹腔镜辅助阑尾切除术（TSLAA）与传统腹腔镜阑尾切除术（LA）的临床疗效和安全性。方法 回顾性分析2017年1月至2019年10月行腹腔镜阑尾切除术且围手术接受加速康复外科（ERAS）方案的急性阑尾炎患者,并根据手术方式分为两组：TSLAA组（47例）和TLA组（92例）。分析比较两组围手术期资料的异同。结果 TSLAA组与LA组在术前一般资料方面具有可比性;TSLAA组的病人术前BMI较低,腹痛持续时间较短。两组患者手术时间及术中出血量无差异。TSLAA组患者在住院期间疼痛控制及满意度评分均优于LA组。但两组术后胃肠功能恢复情况相似。TSLAA组总并发症、感染性并发症、非感染性并发症发生率低于LA组,但并无统计学差异。TSLAA组术中、围手术期费用均明显低于LA组（P<0.05）。结论 TSLAA是一种安全可行的技术,是急性阑尾炎的另一种有效且微创的选择。     

257 incidental appendectomies during total laparoscopic hysterectomy

OBJECTIVE: This retrospective observational report analyzes the demographics, blood loss, length of surgical duration, number of days in the hospital, and complications for 821 consecutive patients undergoing total laparoscopic hysterectomy over a 11-year period stratified by incidental appendectomy. METHODS: A retrospective chart abstraction was performed. ANOVA and chi-square tests were performed with significance preset at P<0.05. RESULTS: Of 821 consecutive patients undergoing total laparoscopic hysterectomy, 257 underwent elective appendectomy with the ultrasonic scalpel, either as part of their staging, treatment for pelvic pain, or prophylaxis against appendicitis. Comparing the 2 groups, no difference existed in mean age of 50+/-10 years or mean BMI of 27.6+/-6.7. Both groups had a similar mean blood loss of 130 mL. Surgery took less time (137 vs 118 minutes, P<0.0012) and the hospital stay was shorter in the appendectomy group (1.5 vs 1.2, P<0.0001) possibly because it was performed incidentally in most cases. No complications were attributable to the appendectomy, and complication types and rates in both groups were similar. Though all appendicies appeared normal, pathology was documented in 9%, including 3 carcinoid tumors. CONCLUSIONS: Incidental appendectomy during total laparoscopic hysterectomy is not associated with significant risk and can be routinely offered to patients planning elective gynecologic laparoscopic procedures, as is standard for open procedures.     

腹腔镜与开腹阑尾切除术的临床比较

目的:比较腹腔镜与开腹手术切除阑尾的优缺点。方法:回顾性分析我院2010年1月1日—2012年3月31日292例行阑尾切除术患者的临床资料,根据手术方法分为单孔法腹腔镜阑尾手术组、多孔法腹腔镜阑尾手术组和开腹阑尾手术组,比较手术时间、出血量、术后排气时间、术后住院时间切口愈合等级及感染率。结果:单孔法腹腔镜阑尾手术组中1例转为多孔法,多孔法腹腔镜阑尾手术组中1例中转开腹,其余患者均完成手术。2例多孔法腹腔镜阑尾手术患者术后并发粘连性肠梗阻,经保守治疗后好转。与传统开腹手术相比,腹腔镜阑尾切除术手术时间短、出血量少、术后排气快、术后住院时间短;对于急性单纯性阑尾炎,单孔腹腔镜手术比多孔法出血更少,瘢痕更小。结论:腹腔镜阑尾切除术对腹部干扰少,单孔法切口更为隐蔽,在熟练掌握手术技术的前提下可以广泛应用。     

低压气腹腹腔镜技术在老年急性阑尾炎中的临床应用

【摘要】 目的 探讨低压气腹腹腔镜技术在治疗老年急性阑尾炎的临床疗效。方法〓回顾性分析2013年1月至2016年1月在我院住院治疗的104例老年急性阑尾炎,常规气腹腹腔镜技术治疗组52例,低压气腹腹腔镜技术治疗组52例,比较两组手术时间、术中出血量、术后并发症、住院时间,及对二氧化碳分压(PaCO₂)、N端脑钠肽(BNP)的影响。结果〓两组患者均顺利完成腹腔镜阑尾切除,无中转开腹。低压气腹组平均手术时间36.6±0.3 min与常规气腹组33.7±11.2 min相比无显著性差异(P=0.17);低压气腹组术中平均出血量40.1±5.3 mL较对常规气腹组38.5±4.3 mL增多,差异无统计学意义;低压气腹组住院时间3.2±1.2 d,较常规气腹组4.5±1.3 d缩短,差异具有统计学意义(P<0.01)。低压气腹组术后并发症2例,与对照组8例相比,差异具有统计学意义(P=0.046)。常规气腹组术后PaCO₂和BNP均较实验组显著升高,差异具有统计学意义(P<0.01)。结论〓低压气腹腔镜在治疗老年急性阑尾炎方面疗效确切,有利于术后快速康复及减少对心肺功能的影响,值得进行临床试用。     

Impact of previous abdominal surgery on laparoscopic appendectomy for acute appendicitis

Background Laparoscopic appendectomy is one of the most commonly performed laparoscopic procedures. Impact of previous abdominal surgery on laparoscopic appendectomy has not been previously reported. Methods From January 2001 to December 2005, 2029 patients with clinically suspected acute appendicitis underwent laparoscopic surgery in our hospital. Of these, 234 patients (11.5%) were found to have other pathology by intraoperative or histologic findings and were excluded from the study. The 1795 patients who underwent laparoscopic appendectomy for acute appendicitis were divided into three groups: group 1, patients without a history of previous abdominal surgery (n = 1652, 92%); group 2, patients with a history of upper abdominal surgery (n = 20, 1.1%); group 3, patients with a history of lower abdominal surgery (n = 123, 6.8%). Data were collected retrospectively by chart review and analyzed for conversion rate, operative time, intraoperative and postoperative complications, and hospital stay. Results Of the 1795 patients, 13 (0.7%) were converted to open appendectomy because of technical difficulty. Overall mean operative time was 57.2 (range, 20–225) min. There was no mortality or intraoperative complications. Overall postoperative complication rate was 10.7% (n = 193): rate of surgical wound infection was 8.2 % (n = 147), surgical wound seroma 1.3% (n = 24), and intra-abdominal abscess 0.8% (n = 14). Overall postoperative hospital stay averaged 3.2 (range, 0–39) days. There were no significant differences between the three groups regarding the conversion rate (0.8% vs. 0% vs. 0%, p = 0.567), operative time (57.3 vs. 55.8 vs. 56.9 min, p = 0.962), postoperative complication rates (10.7 vs. 10 vs. 12.2%, p = 0.863), and hospital stay (3.2 vs. 3.6 vs. 3.1 days, p = 0.673). Conclusions Previous abdominal surgery, whether upper or lower abdominal, has no significant impact on laparoscopic appendectomy for acute appendicitis.     

Outpatient laparoscopic appendectomy

Laparoscopy has allowed surgeons the ability to perform procedures which result in less postoperative discomfort, earlier return to daily activities, and better cosmesis. For example, laparoscopic cholecystectomy has virtually replaced open cholecystectomy, and many of these operations are performed in the outpatient setting. The role of laparoscopic appendectomy is yet to be defined, however. Over an 18-month period from February 1992 to July 1993, 75 laparoscopic appendectomies were performed at Kaiser Permanente Medical Center in Los Angeles. Thirty-five of the patients undergoing this procedure were outpatients. While there were a total of three complications, including two intraabdominal abscesses, there were no complications in the outpatient appendectomy group. Laparoscopic appendectomy may be safely performed in the outpatient setting in patients with acute nonperforated appendicitis.