坏疽、化脓性阑尾炎合并穿孔的腹腔镜治疗

Laparoscopic appendectomy for gangrenous suppurative perforative appendicitis

目的:探讨腹腔镜阑尾切除术(laparoscopic appendectomy,LA)治疗坏疽、化脓性阑尾炎合并穿孔的安全性和可行性。方法:总结2002年1月至2007年12月应用LA治疗93例坏疽、化脓性阑尾炎合并穿孔患者的临床资料,术中处理阑尾根部时,使用Endo-loop阑尾根部双重套扎或双重钛夹夹闭46例,直接腹腔镜下丝线打结阑尾根部23例,间断缝合阑尾残端加医用生物蛋白胶覆盖15例,清除阑尾残余组织加医用生物蛋白胶覆盖残端,放置硅胶引流管9例。结果:93例手术均获成功,无中转开腹,平均手术时间72min,术后排气时间22.5h,11例术后使用止痛药或止痛针,1例戳口感染,无肠漏及腹腔脓肿发生,平均住院5d。结论:随着腹腔镜技术的不断成熟、完善,对于坏疽、化脓性阑尾炎合并穿孔患者行LA是安全可行的,具有患者创伤小、痛苦轻、疤痕小、康复快、并发症少等优点。

Objective：To explore the feasibility and safety of laparoscopic appendectomy for gangrenous suppurative perforative appendicitis. Methods：Ninety-three patients with root gangrenous perforative appendicitis were treated with laparoscopic appendectomy from Jun. 2002 to Dec. 2007,and the clinic data were summarized. When dealing with the appendical root,46 cases were used double Endo-loop to ligate the appendical root or double titanium clips clipping,23 cases were directly used laparoscopic appendectomy to knot the appendical root, 15 cases were used the interrupted suture appendectomy stump and fibrin glue coverage,9 cases of appendical remnant tissue were removed,covered with fibrin glue and placed silica drainge tube. Results：All operations were successful and no one had conversion. The mean operative time was 72min, the exhaust time was 22.5 hours after operation. Eleven cases were treated with analesic after operation. One case had pore infection. No case appeared residual abscess and colic fistula. The mean time for hospitalization was 5 days. Conclusions：Laparoscopic appendectomy for gangrenous suppurative perforative appendicitis is safe and feasible with advantages of minimal invasive,less scar,rapid recovery,fewer complications and so on.