阑尾穿孔腹腔镜阑尾切除术41例临床分析

目的：总结腹腔镜阑尾切除术治疗阑尾穿孔并腹膜炎的效果。方法：分析41例患者阑尾穿孔并腹膜炎行腹腔镜手术的临床资料，并随机选择常规开腹手术40例为对照组，比较两组的手术时间、术后切口感染、腹腔残余感染及肠粘连等并发症的发生率。结果：腹腔镜组手术时间45～95min，平均61min，几乎无出血，术后穿刺口感染1例，肠间积液1例，无近期肠粘连等并发症。对照组40例手术时间50～110min，平均58min，腹腔残余感染8例，切口感染7例，近期肠粘连4例。结论：腹腔镜阑尾切除术是阑尾穿孔并腹膜炎的首选治疗方式，具有开腹手术无法比拟的优点，可明显降低切口感染、腹腔残余感染及肠粘连等并发症。取出阑尾时尽量不与穿刺口接触及术毕彻底冲洗腹腔是避免以上并发症的关键。

Clinical analysis of laparoscopic appendectomy in 41cases with perforated appendix

Objective:To conclude the effects of laparoscopic appendectomy(LA) with perforated appendix and peritonitis.Methods: The clinical data of 41 patients with perforated appendix and peritonitis who underwent LA were analyzed, while 40 patients who received routine laparotomy were randomely selected as contral group.The operative time and complications were compared.Results: The mean operative time of laparoscopic group was 61min(45-95min), and very few complications were found including one puncture hole infection, and one innerintestinal hydrops, with almost no bleeding and recent intestinal adhesion. While in the control guoup,the average operative time was 58min(50-110min),abdominal cavity remnant infection,incision infection and recent intestinal adhension were found in 8,7and 4 cases respectively.Conclusions: Laparoscopic appendectomy(LA) is the first choice to treat perforated appendix and peritonitis,with much fewer complications than open surgery,such as incision infection, abdominal cavity remnant infection and intestinal adhension. No contacting with the puncture hole as far as possible when taking out the appendix and washing the abdominal cavity thoroughly are important to reduce such complications.