腹腔镜阑尾切除在体胖患者手术中的应用

目的:探讨腹腔镜阑尾切除术(laparoscop ic appendectomy,LA)在体胖患者手术中的应用价值。方法:分析我院20例体胖患者LA术中操作特点。结果:手术过程顺利,平均手术时间30m in,术后平均下床活动时间6h,平均住院时间3d。无一例伤口感染。结论:LA对体胖患者有明显优势,创伤小,易于手术操作,效果突出。     

腹腔镜阑尾切除术

<正> 我院1992年5月至1995年底用腹腔镜作阑尾切除518例,临床效果满意,现报告如下。 1 临床资料 1.1 一般资料 本组男性286例,占55.21％;女性232例,占44.79％。最大年龄79岁,最小年龄9岁,平均年龄39岁。急性阑尾炎129例(24.9％);阑尾穿孔伴腹膜炎161例(31.08％);化脓性阑尾炎108例(20.85％);坏疽性阑尾炎81例(15.63％);非急性阑尾炎48例(9.26％);后位阑尾炎216例(41.69％);肝下阑尾炎48例(9.26％)。。518例均在腹腔镜下完成手术,无一例中转开腹,手术成功率达100％;治愈率100％。     

腹腔镜阑尾切除术56例临床分析

我院2003年4月~2004年10月共开展腹腔镜阑尾切除术(LA)56例,术后随访11~30月,效果满意,现报道如下。1资料与方法1·1临床资料56例中男32例,女24例,6~72岁,平均36岁。病理类型:慢性阑尾炎16例,急性单纯性阑尾炎22例,化脓性阑尾炎11例,坏疽性阑尾炎7例合并穿孔3例。其中,腹膜后阑     

腹腔镜阑尾切除术368例报告

目的总结腹腔镜阑尾切除术（laparoscopic appendetectomy，LA）的经验。方法回顾性分析1998年3月～2005年3月我院行LA治疔368例阑尾炎的临床资料，其中单纯性阑尾炎35例，化脓性阑尾炎276例，阑尾穿孔腹膜炎39例，慢性阑尾炎18例。结果5例中转开腹。363例成功完成LA，手术时间22—55min，平均30．5min；术中出血量2-10ml。腹腔残余感染、粘连性肠梗阻各1例，保守治愈；盆腔脓肿1例，腹腔镜下脓肿引流治愈。结论熟练掌握腹腔镜技术治疗阑尾炎可取得满意效果。     

腹腔镜阑尾切除术120例报告

<正> 在内镜手术广泛普及与快速发展的今天,腹腔镜阑尾切除术(Laparoscopic appendectomy,LA)仍有一些争议,但现代外科以最小的创伤来治愈疾病的目标,促使许多外科医师不断的探索。大量资料表明LA已从朦胧的晨雾中逐渐显露出其独特的风姿,成为一种首选的比较标准的术式。 资料与方法 1 临床资料 本组120例,男58例,女62例,年龄13～54岁,慢性阑尾炎35例,急性阑尾炎71例,坏疽穿孔型阑尾炎11例,阑尾周围脓肿3例,LA术中联合手术共9例,占7.5％;卵巢囊肿摘除术3例,右侧附件切除1例,胆囊切除2例,粘连松解3例。其它术中阳性发现10例占8.3％,附件盆腔结核1例,多囊卵巢1例,慢性胆囊炎(胆囊周围粘连)2例,十二指肠球溃疡瘢痕1例,肝硬变(纤维化)2例,肝脏浊     

腹腔镜两孔法小儿阑尾切除术

自 2 0 0 1年 7月至 2 0 0 2年 7月 ,我们对适宜患者使用腹腔镜两孔法行小儿阑尾拖出腹腔外切除术 6 8例 (简称“两孔法”) ,效果良好 ,现报告如下。1　资料与方法1 1　临床资料　本组 6 8例中男 4 0例 ,女 2 8例。 2～ 4岁 30例 ,5～ 7岁 2 5例 ,8～ 11岁 13例。临床均有腹痛、呕吐、发热、ＷＢＣ上升、右下腹压痛、肌紧张等典型急性阑尾炎症状及体征。病程 12～ 2 4ｈ。术后病检示急性单纯性阑尾炎 4 5例 ,急性化脓性阑尾炎 2 3例。1 2　手术方法　术前常规使用抗生素 ,置尿管。气管插管全麻或持续硬膜外麻醉。建立ＣＯ2 气腹 ,压力 1 33…     

腹腔镜阑尾切除术33例体会

<正> 电视腹腔镜阑尾切除由于创伤小、恢复快、并发症少以及美观等优点受到患者欢迎。我院自1998年4月至1998年9月开展腹腔镜手术以来,共完成腹腔镜阑尾切除33例,报告如下:     

腹腔镜辅助下两孔法阑尾切除术

<正> 1993年5月至1997年6月,我们在腹腔镜阑尾切除术(laparoscopic appendectomy,LA)的启发下,结合开放式阑尾切除术(open appendectomy,OA),选择部分病例施行了腹腔镜辅助两孔法阑尾切除术39例,效果满意,报道如下。 资料与方法 1.1 临床资料 本组39例,男19例,女20例,12～69岁。临床诊断:慢性阑尾炎27例,急性阑尾炎12例。择期手术23例,急诊手术16例。麻醉方法:全麻27例,硬膜外麻醉12例。     

腹腔镜阑尾切除术64例

目的：观察腹腔镜阑尾切除术的疗效。方法：回顾性分析64例行腹腔镜阑尾切除术患者的临床资料。结果：64例手术均获成功。手术时间35~72min,平均43min。术中出血2~10mL。术后2例戳孔感染,经换药后治愈。平均住院4.5d。结论：腹腔镜阑尾切除术具有创伤小、恢复快、并发症少、住院时间短和美容效果好等优点,是治疗阑尾炎一种安全有效的手术方式。     

腹腔镜下阑尾切除术153例临床分析

目的总结腹腔镜阑尾切除术(laparoscopic appendectomy,LA)的应用经验。方法回顾性分析我院2009年5月至2010年8月期间153例行LA手术患者的临床资料。结果 153例中男74例,女79例;年龄8~76岁,平均32.5岁。其中慢性阑尾炎7例,急性单纯性阑尾炎41例,急性化脓性阑尾炎81例,急性坏疽穿孔性阑尾炎24例。149例在腹腔镜下顺利完成手术,4例因阑尾周围组织水肿及粘连明显、镜下解剖不清而中转开腹。手术时间30~90 min,平均51 min。住院时间3~8 d,平均5 d。发生脐部戳孔感染5例。随访1~12个月(平均5个月),无术后出血、腹腔脓肿及粘连性肠梗阻发生。结论 LA创伤小,疤痕小,恢复快,住院时间短,并发症少,安全性高。     

肥胖病人行腹腔镜阑尾切除术与开腹手术的疗效对比分析

目的对比分析腹腔镜阑尾切除术和开腹阑尾切除术治疗肥胖病人阑尾炎的手术效果。方法回顾性分析2003年1月-2007年11月我院行阑尾切除术治疗肥胖病人阑尾炎104例的临床资料。其中,行腹腔镜阑尾切除术73例,开腹阑尾切除术31例。比较两种术式的手术时间、切口感染和残余脓肿的发生率、住院时间和住院费用的差异。结果比较腹腔镜阑尾切除术组和开腹阑尾切除术组以上各项指标（除住院时间外）差异均无显著性意义（P〉0．05）。结论腹腔镜阑尾切除术治疗肥胖病人阑尾炎与开腹阑尾切除术相比具有创伤小、恢复快、并发症少和平均住院时间短等优点,是治疗肥胖病人阑尾炎较理想的手术方式。     

Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity

OBJECTIVE: To determine the safety and efficacy of laparoscopic Roux-en-Y gastric bypass for the treatment of morbid obesity. SUMMARY BACKGROUND DATA: Laparoscopic Roux-en-Y gastric bypass is a new and technically challenging surgical procedure that requires careful study. METHODS: The authors attempted total laparoscopic Roux-en-Y gastric bypass in 281 consecutive patients. Procedures included 175 proximal bypasses, 12 long-limb bypasses, and 9 revisional procedures from previous bariatric operations. The gastrojejunostomy and jejunojejunostomy were primarily constructed using linear stapling techniques. RESULTS: Eight patients required conversion to an open procedure (2.8%). The mean age of the patients was 41.6 years (range 15-71) and 87% were female. The mean preoperative body mass index was 48.1 kg/m2. The operative time decreased significantly from 234 +/- 77 minutes in the first quartile to 162 +/- 42 minutes in the most recent quartile. Postoperative length of stay averaged 4 days (range 2-91), with 75% of patients discharged within 3 days. The median hospital stay was 2 days. No patient died after surgery. Complications included three (1.5%) major wound infections (each followed a reoperation for a complication or open conversion), incisional hernia in 5 patients (1.8%), and anastomotic leak with peritonitis in 14 patients (5.1%). Three gastrojejunal leaks were managed without surgery, four by laparoscopic repair/drainage, and three by open repair/drainage. Only three patients had anastomotic leaks in the most recent 164 procedures (1.8%) since the routine use of a two-layer anastomotic technique. Data at 1 year after surgery were available in 69 of 96 (72%) patients (excludes revisions). Weight loss at one year was 70 +/- 5% of excess weight. Most comorbid conditions resolved by 1 year after surgery; notably, 88% of patients with diabetes no longer required medications. CONCLUSIONS: Laparoscopic gastric bypass demonstrates excellent weight loss and resolution of comorbidities with a low complication rate. The learning curve is evident: operative time and leaks decreased with experience and improved techniques. The primary advantage is an extremely low risk of wound complications, including infection and hernia.     

Mini-laparoscopic versus laparoscopic approach to appendectomy

Background  

The purpose of this clinical study is to evaluate the feasibility of using 2-mm laparoscopic instruments to perform an appendectomy in patients with clinically suspected acute appendicitis and compare the outcome of this mini-laparoscopic or "needlescopic" approach to the conventional laparoscopic appendectomy.     

Two-trocar laparoscopic-assisted appendectomy versus conventional laparoscopic appendectomy in patients with acute appendicitis

BACKGROUND: In order to reduce abdominal trauma and operative costs we have adopted a two-trocar laparoscopic-assisted appendectomy for patients with acute appendicitis. In the current study, the proposed technique is prospectively evaluated against conventional laparoscopic appendectomy with respect to feasibility, safety, and postoperative outcome. MATERIALS AND METHODS: Between July 2001 and July 2003, 83 consecutive patients were admitted with clinically diagnosed acute appendicitis and were randomly assigned to two-trocar laparoscopic-assisted appendectomy (n = 40, 48.2%) or conventional laparoscopic appendectomy (n = 43, 51.8%). RESULTS: Two-trocar laparoscopic-assisted appendectomy was successfully completed in 30 patients (80.1%). Four patients initially scheduled for two-trocar laparoscopic-assisted appendectomy (10.8%) were converted to laparotomy due to excessive body weight (BMI > or = 40), while an additional 5-mm infraumbilical trocar was inserted in another 3 patients (8.1%). The procedure was associated with decreased operative time and more rapid return to normal activity compared to laparoscopic appendectomy (P < 0.001 and P = 0.038, respectively). There was no statistically significant difference regarding the duration of hospitalization or the morbidity rate between the two groups. Conversion of the initial procedure was associated with increased wound infection rate and higher morbidity (P = 0.032 and P = 0.018, respectively). CONCLUSION: Two-trocar laparoscopic-assisted appendectomy represents a promising minimally invasive procedure for the treatment of acute appendicitis. It is fast and easy to perform, and it is expected to decrease the overall cost of laparoscopic appendectomy. Its only contraindication is excessive body weight; it remains to be evaluated in the setting of perforated appendicitis and retrocecally located appendices.     

Factors associated with conversion to laparotomy in patients undergoing laparoscopic appendectomy

BACKGROUND: Laparoscopic appendectomy (LA) has been increasingly adopted for its advantages over the open technique, but there is a possibility of conversion to open appendectomy (OA) if complications occur or the extent of inflammation prohibits successful dissection. This study aimed to identify the preoperative predictors for conversion from laparoscopic to open appendectomy. STUDY DESIGN: Medical records of 705 consecutive patients who underwent surgery for suspected appendicitis were reviewed retrospectively. LA was attempted in 595 patients by 25 different surgeons. Factors evaluated were age, gender, body mass index, previous abdominal surgery, previous appendicitis attack, pain, nausea, vomiting, fever, duration of symptoms, local or diffuse tenderness, leukocyte count and surgeon's experience in LA. RESULTS: Conversion to OA occurred in 58 patients (9.7%). The most common reason for conversion was dense adhesions due to inflammation, followed by localized perforation and diffuse peritonitis. Based on 261 patients evaluated by CT scan preoperatively, significant factors in the final multivariate analysis associated with conversion to OA were age > or = 65 [Odds ratio (OR) = 3.78, 95% CI:1.11-12.84], diffuse tenderness on physical examination (OR = 11.32, 95% CI: 1.32-96.62), and a surgeon with less experience in LA (< or = 10 operations, OR = 3.38, 95% CI:1.02-11.17). The presence of significant fat stranding associated with fluid accumulation, inflammatory mass or localized abscess in CT scan also significantly increased the possibility of conversion (OR = 5.60, 95% CI:2.48-12.65). CONCLUSIONS: Identifying the potential factors for conversion preoperatively may assist the surgeons in making decisions concerning the management of patients with appendicitis and in the judicious use of LA.     

腹腔镜阑尾切除术用于女性患者的远期疗效

目的:评价腹腔镜阑尾切除术用于治疗女性阑尾炎的远期效果。方法:回顾分析2004年2月至2008年2月因阑尾炎入院的157例女性患者的临床资料,其中传统开腹手术组84例,腹腔镜手术组73例,比较两组术后病理、切口感染率、腹腔残余脓肿、粘连性肠梗阻等并发症,评估腹腔镜阑尾切除术预防盆腔炎和不孕症的效果。结果:两组切口感染率、腹腔残余脓肿、粘连性肠梗阻、盆腔炎发生率和术后住院时间差异有统计学意义(P0.05)。结论:女性阑尾炎患者特别是孕龄女性,建议行腹腔镜阑尾切除术。     

Single-center comparison of outcomes between laparoscopic appendectomy and transumbilical laparoscopic assisted appendectomy

PurposeAppendectomy is the most common pediatric emergency surgery performed to date. This study compared outcomes between laparoscopic appendectomy (LA) and transumbilical laparoscopic assisted appendectomy (TULAA) for 1154 uncomplicated patients across 5 years at a single institution. Primary outcomes include length of stay (LOS), post-operative complications, pain score, and operating room (OR) time.MethodsDemographic and clinical data was collected for 1154 eligible patients treated for uncomplicated appendicitis between August 2014–October 2019, with 830 patients in the LA group, and 324 in the TULAA group. Mixed effects modeling procedure using logistic and linear regression examined the effect of surgery type on the four primary outcomes after adjustment for potential clustering effect of surgeon and confounding factors.ResultsOf 1154 patients, 62.7% were male, and mean (SD) age was 10.9 (3.6) years. Median [IQR] LOS was 28.0 h [22.0, 36.0], mean (SD) OR time was 29.0 (10.0) minutes, and median [IQR] pain at maximum level was 5.5 (2.7). The complication rate overall was <5.0% and did not differ between TULAA and LA groups (p > 0.05). OR time was reduced by an average of 5.2 min in the TULAA group (p < 0.001), pain did not differ between groups overall (p > 0.05), and patients were more likely to be discharged within 24 h in patients who underwent TULAA (OR = 5.3 [1.6, 17.4], p = 0.007).ConclusionRetrospective analysis of 1154 pediatric appendectomies, found no difference in complications between single- and three-incision laparoscopic procedures (TULAA vs. LA). Findings suggest TULAA is a safe procedure for acute appendicitis in pediatrics.Level of EvidenceIV.     

Elective laparoscopic appendectomy in patients with familial Mediterranean fever

Familial Mediterranean fever (FMF) also known as bereditary polyserositis, is an inherited disorder commonly found in Armenians, Turks, Arabs, Balkans, and Jews originating from North African countries. The diagnosis of FMF is based on clinical findings and family history, as no specific diagnostic test is yet available. One of its main clinical features is recurrent acute episodes of peritonitis. During such an episode, physical examination and laboratory findings may be similar to those for acute appendicitis. Therefore up to two-thirds of FMF patients undergo emergency appendectomy, with the appendix being normal in most cases. As laparoscopic appendectomy has proved to be safe and advantageous, and to prevent misdiagnosis and unnecessary emergency surgery, we performed elective laparoscopic appendectomy in 13 FMF patients ranging in age from 8 to 32 years. They had been suffering from the disease for 1 to 12 years (mean 3.8) and had had an average of 3.5 yearly episodes of FMF peritonitis. All procedures were concluded by laparoscopy without conversion to open surgery. The average postoperative hospital stay was 3.07 days. The only complication was superficial wound infection in one patient (7.6%), and the mean time to regain full normal activity was 8.5 days. We conclude that elective laparoscopic appendectomy in FMF patients is safe. It helps to exclude appendicitis as a cause for peritonitis in these patients and may prevent unnecessary emergency surgery.

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Resumen La Fiebre Mediterránea Familiar (FMF), también conocida como Poliserositis Hereditaria, es una enfermedad hereditaria que se encuentra comunmente en Armenios, Turcos, Arabes, Balcanos y Judíos originarios de las naciones del norte de Africa. El diagnóstico definitivo de la FMF se fundamenta en los hallazgos clínicos y en la historia familiar, puesto que aun no se ha hallado una prueba diagnóstica especifica. Entre sus principales características clínicas están los episodios agudos recurrentes de peritonitis. Durante cada episodio los hallazgos en el examen clínico y en las determinaciones de laboratorio pueden ser muy similares a los de la apendicitis aguda. Por consiguiente, hasta dos tercios de los pacientes con FMF son sometidos a apendicectomía de urgencia con el hallazgo de un apéndice normal en la mayoría de los casos. Puesto que la apendicectomía laparoscópica ha demostrado ser segura y ventajosa, y con miras a prevenir un error diagnóstico y una cirugía de emergencia innecesaria, hemos practicado la apendicectomia laparoscópica en 13 pacientes con FMF con edades entre 8 y 32 años. Estos pacientes sufrían la enfremedad entre 1 y 12 años (promedio 3.8), y presentaban un promedio de 3.5 episodios anuales de peritonitis por FMF. La totalidad de los procedimientos se completaron por laparoscopia y ninguno requirió conversión a cirugía abierta. El promedio de estancia postoperatoria fue de 3.07 días. La única complicación fue una infección superficial de herida en una paciente (7.6%) y el tiempo medio hasta la recuperación de actividad normal fue de 8.5 días.Nuestra conclusión es que la apendicectomía laparoscópica electiva en pacientes con FMF es un procedimiento seguro. Ayuda a excluir la apendicitis como causa de la peritonitis en los pacientes con FMF y puede prevenir una cirugía de emergencia innecesaria.

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Résumé La fièvre Méditerranéenne Familiale (FMF) est également connue sous le nom de Polysérite Héréditaire, une maladie présente dès la naissance chez les Arméniens, Turcs, les habitants des Balkans et les Juifs d'Afrique du Nord. Le diagnostic définitif de FMF est basé sur les données cliniques et l'histoire familiale puisqu'il n'y existe encore aucun test diagnostique spécifique. Un des principaux caractères cliniques de la maladie est la survenue de tableau de péritonite récidivante, qui ressemble, cliniquement et biologiquement, en tous points à une crise d'appendicite aiguë. Ceci explique pourquoi jusqu'à deux tiers des patients avec une FMF sont opérés en urgence. alors que leur appendice est le plus souvent normal. Comme l'appendicectomie laparoscopique a été démontrée comme une méthode súre, et pour éviter de faire un diagnostic erroné et éviter une chirurgie inutile, nous avons réalisé une appendicectomie laparoscopique chez 13 patients ayant une MFM dont les áges allaient de 8 à 32 ans. Tous les patients souffraient de leur MFM entre 1 et 12 ans (durée moyenne=3.8 ans) et présentaient une moyenne de 3.5 épisodes de tableaux de péritonites par an. Dans tous les cas, il a été possible de conclure l'intervention par laparoscopie sans avoir besoin de convertir en chirurgie ouverte. La durée moyenne de séjour à l'hôpital a eté de 3.07 jours. Il y a eu une seule complication: une infection superficielle de la plaie opératoire (7.6%) et la durée moyenne avant la reprise d'activité normale a été de 8.5 jours. Nous concluons que laparoscopie est utile et sûre chez le patient ayant une MFM. Elle permet d'exclure l'appendicite comme l'origine du tableau de péritonite chez ces patients, et aide ainsi à éviter une chirurgie inutile.

     

Comparison of laparoscopic-assisted appendectomy with intracorporal laparoscopic appendectomy and open appendectomy.

BACKGROUND: A laparoscopic appendectomy is associated with less postoperative pain and a shorter postoperative stay than the open technique. However, the open technique is faster and less expensive than the completely laparoscopic method. A laparoscopic-assisted appendectomy has the advantages of both the laparoscopic and open techniques. METHODS: A retrospective study involving 83 patients was performed comparing the three different techniques. The comparison studied operating time, surgical expense, and postoperative stay. RESULTS: The completely laparoscopic method was performed on 24 patients with an average surgical time of 88.9 minutes, average charges of $604, and average postoperative stay of 2.6 days. The open technique was performed on 26 patients with a surgical time of 77.1 minutes, charges of $42, and a postoperative stay of 2.4 days. The laparoscopic-assisted technique was performed on 33 patients with a surgical time of 70.3 minutes, charges of $208, and a postoperative stay of 1.8 days. CONCLUSION: The laparoscopic-assisted method of appendix removal can be performed as efficiently as the open technique but at <67% of the cost of the complete laparoscopic method. The postoperative stay is shorter for the laparoscopic-assisted technique than for the open technique. Thus, the laparoscopic-assisted technique is a cost-effective method for removing the appendix.