腹腔镜阑尾切除术耻骨上主要操作通道的设计与应用

The design and application of major operation thoroughfare above pubis in the laparoscopic appendectomy

目的:设计腹腔镜阑尾切除术中更符合美学要求和更利于操作的主要操作通道入路位置一耻骨上操作通道。方法:术前不需留置尿管和胃管,采用硬膜外麻醉,患者取头低稍左侧卧位,建立气腹后,在脐缘切口插入10mm的套管,放入腹腔镜,在直视下从腹正中线耻骨联合上30mm处插入10mm的套管作为主要操作通道,在麦氏点插入5mm的套管。助手通过麦氏点5mm套管用抓钳提起阑尾,术者通过耻骨上10mm套管使用各种器械完成阑尾切除的操作。结果:患者在术后第3～5天出院,均无并发症,切口甲级愈合,仅1例因阑尾根部坏疽穿孔而中转开腹手术。术后随访20例0.3～5年,平均3年,疗效为全优。结论:本设计中采用的套管位置美观,操作方法简单,所需器械普通,费用低,便于推广应用,更具有腹腔镜手术所具有的安全、美观、损伤轻、恢复好和并发症少等优点。

Objective:To design the major operation thoroughfare that in the laparoscopic appendectomy which will more fits the requirement of aesthetics and easier to go into the thoroughfare above pubis. Methods: The urine pipe and stomach pipe needn' t be kept before the operation. The patients were performed anaethesia outside the hard membrane , then inserted the casing pipe of 10mm above the pubic bones 30mm as the major operated thoroughfare , then completed laparoscopic appendectomy. Results: 23 patients left hospital after the operation in 3 - 5days without complications, only 1 patient was laparotomied because of the appendix root gangrene perforation. 20 patients were followed up after the operation in 0.3 - 5 year(average 3 years) ,the effects were excellent.Conclusion:This method has the advantages of pleasing location of the pipe, simple procedure , low cost and so on.