腹腔镜阑尾切除术的常见难点与手术技巧

The common difficulties and surgical techniques of laparoscopic appendectomy

目的：探讨腹腔镜阑尾切除术（laparoscopic appendectomy,LA）的常见难点和手术技巧。方法：回顾分析我院近3年为220例阑尾炎患者行LA的临床资料。结果：216例在腹腔镜下顺利完成手术,4例中转开腹,阑尾取出困难62例,特殊位置阑尾18例,阑尾根部坏疽穿孔13例,阑尾周围重度粘连19例,阑尾显露困难12例,系膜出血7例,手术时间35-130min,住院时间3-9d,1例戳孔感染经对症处理后痊愈,无术后出血、肠粘连等并发症发生。结论：耐心、细致、熟练的腹腔镜外科技术是保证各种阑尾炎一期切除、减少并发症的关键。

Objective：To explore the common difficulties and surgical techniques of laparoscopic appendectomy （LA）. Methods：The clinical data of 220 cases with appendicitis receiving LA in the last 3 years were analyzed retrospectively. Results：Two hundred and sixteen procedures of these cases were successfully done by laparoseopy, the other four cases conversed to conventional operation. It was difficult to dislodge appendix in 62 cases and to reveal appendix in 12 cases. There were 18 cases of ectopic appendix, 13 cases of appendix with gangrenous perforation at root, 19 cases of severe adhesions around the appendix and 7 cases of the mesentery bleeding. The operative time were from 35min to 130min,the time of stay in hospital were 3-9 days. One case was complicated by infection of poke holes,who recovered after treatment. No other complication was found, such as postoperative hemorrhage, ankylenteron and so on. Conclusions ： Patience, meticulosity and skillful technique of laparoscopy are the most important factors to guarantee the success of laparoscopic appendectomy and reduce the rate of complication.