悬吊辅助法腹腔镜阑尾切除术

目的:总结悬吊辅助法在腹腔镜阑尾切除术中的应用经验。方法:带线深静脉置管针于麦氏点穿刺入腹,以穿刺针腹腔内侧端及线夹角固定阑尾(包括系膜),绷紧穿刺针腹腔外"2"号尼龙线,小直钳固定,调整穿刺针将阑尾固定在合适位置,以便手术操作。超声刀切断阑尾系膜,至阑尾根部,用16 mm Hem-o-lok结扎处理阑尾根部,阑尾残端电刀烧灼。结果:50例成功施行悬吊辅助法腹腔镜阑尾切除术,2例因阑尾根部穿孔中转开腹。手术时间30~70 min,平均(41.0±7.4)min,不包括麻醉前后及准备器械时间;失血量5~10 ml,术后肛门排气时间4~26 h,平均(18.0±5.6)h。术后未使用止痛剂。术后病理示急性单纯性阑尾炎3例,急性化脓性阑尾炎47例,坏疽性阑尾炎2例。住院3~7 d,平均(4.0±0.8)d。术后2个月后复查,均无切口感染、切口疝、肠梗阻及右下腹疼痛等并发症发生。结论:悬吊辅助法腹腔镜阑尾切除术未明显增加手术时间与手术难度,除具有三孔腹腔镜阑尾切除术康复快、并发症少等优点外,美容效果更佳。

Laparoscopic appendectomy with suspension assistance techniques

Objective:To summarize skills of laparoscopic appendectomy (LA) with suspension assistance techniques.Methods:Surgeons punctured a deep vein catheter needle with thread into the abdominal cavity at McBurney point under laparoscopic display,and fixed the appendix (including mesentery) in the intersection angle of the inner end of the needle and its thread.The No.2 nylon thread was tightened outside abdominal cavity and fixed with a small straight clamp,and the needle was adjusted to fix appendix in the right position to facilitate surgical operation.The appendix (including mesentery) was cut off to appendix root with ultrasonic knife,and ligated with a 16 mm Hem-o-lok clip.Finally,appendix stump was cauterized with electric knife.Results:LA with suspension assistance was successfully performed in fifty cases of appendicitis.Only two cases were converted to laparotomy due to perforation of the appendix root.The operation time was (41.0±7.4) min (range 30-70 min),the preparation time of anesthesia and instruments was not included.The bleeding volume was 5-10 ml.The time of anal exsufflation was (18.0±5.6) h (range 4-26 h).No analgesic was used after surgery.The postoperative pathology revealed 3 cases of acute simple appendicitis,47 cases of acute purulent appendicitis and 2 cases of gangrenous appendicitis.The hospital stay was (4.0±0.8) d (range 3-7 d).No cases showed any complications such as incision infection,incisional hernia,intestinal obstruction or right lower quadrant pain in two months after surgery.Conclusions:The surgical time and difficulty is not significantly increased in LA with the assistance of suspension techniques.Besides the same merit as three-port LA like quick recovery and few complications,it has better cosmetic satisfaction.