腹腔镜下阑尾残端的处理体会

目的:研究腹腔镜阑尾切除术(laparoscopic appendectomy,LA)术中阑尾残端的处理方法。方法:收集2010年10月至2016年4月448例行LA患者的临床资料。术中采取3种方法处理阑尾残端:应用套扎线行阑尾残端双重套扎(套扎法,n=312)、荷包缝合阑尾残端(荷包缝合法,n=112)、可吸收线缝合阑尾残端(可吸收线缝合法,n=24)。结果:套扎法312例患者基本恢复良好,术后11例出现右下腹轻微痛,2～3 d后消失。荷包缝合法112例患者术后恢复良好。可吸收线缝合法24例患者术后基本恢复良好,3例化脓性阑尾炎患者术后出现发热、腹痛,2～4 d后排气,症状消失。结论:LA术中处理阑尾残端应遵循开腹手术的处理原则,套扎阑尾残端方便可行,节省时间;荷包缝合包埋法是首选方法;可吸收线缝合阑尾残端适于阑尾根部坏疽的患者。

The processing experience of appendix stump in laparoscopic appendectomy

Objective:To summarize the different processing methods of appendix stump in laparoscopic appendectomy ( LA) . Methods:The study performed a retrospective study on 448 patients who underwent LA between Oct. 2010 and Apr. 2016. Three meth-ods were adopted to process appendix stump,of which 312 cases were treated with double ligation using ligation loop,112 cases with purse-string suture,24 cases with direct absorbable suture. Results:Patients with ligation basically recovered well, mild right lower quadrant abdominal pain was found in 11 cases,and disappeared after 2-3 d. Patients with purse-string suture recovered well. Patients with absorbable suture basically recovered well,3 patients of suppurative appendicitis suffered postoperative fever and abdominal pain, which disappeared after venting in 2-4 d. Conclusions:The processing of appendix stump in LA should follow the principles of open ap-pendectomy. In general,the ligation of appendix stump is convenient,feasible and time-saving;and purse-string suture and embedding appendix stump is highly recommended;besides,direct suture is applicable to the appendix stump with gangrene.