单极电凝和系膜结扎在腹腔镜阑尾切除术中的应用

The application of monopolar electrocoagulation and ligation of mesoappendix in laparoscopic appendectomy

目的:探讨单极电凝和系膜结扎在腹腔镜阑尾切除术(laparoscopic appendectomy,LA)中的应用价值。方法:为129例患者行三孔法LA。经脐上缘、右下腹、左侧腹直肌外缘分别穿刺10mm、5mm、5mm Trocar,找到阑尾分离粘连后用弹簧抓钳提起阑尾系膜,弯钳穿透系膜无血管区,用7号丝线双重结扎,电凝钩烧灼离断。阑尾根部用7号丝线结扎,距此线上方约1cm处再结扎一道,中间剪断,烧灼消毒断端粘膜。将阑尾置入标本袋经脐孔取出。结果:1例因腹膜内位阑尾中转开腹,1例因系膜较窄将系膜和阑尾根部一同结扎中转开腹。2例因系膜粘连难以分离仅行烧灼。所有患者均无腹腔内出血、脓肿、残株阑尾炎等并发症发生。结论:单极电凝和系膜结扎在LA中应用简单,经济,可靠,在无超声刀的单位更值得推广。

Objective：The aim of this study was to investigate the utilization of the monopolar electrocoagulation and mesoappendix ligation in laparoscopic appendectomy （LA）.Methods：Three-port LA was applied in 129 patients.10mm,5mm and 5mm Trocars were placed at the upper edge of umbilicus,right lower quadrant and exterior margin of left rectus abdominis.The adhesion around appendix was separated and the mesoappendix was seized by the spring grasping forceps when the appendix was found.The curved forceps perforated the avascular area of the mesoappendix and then the silk thread was drawn through it.The mesoappendix was tied twice and the distal mesoappendix was cut subsequently by monopolar electrocoagulation hook.Two ligations with silk thread were performed on the appendix,one on the root and the other on the distal end about 1cm away from the first one.The appendix was transected between the two ligations.The two sections were sterilized by the monopolar electrocoagulation hook.The appendix was extracted in a sample pocket.Results：One case was converted to laparotomy because intraperitoneal appendix.Because of the narrow mesoappendix,the appendix and mesoappendix were ligated together in 1 patient,who was converted to open surgery.Mesoappendix was only cauterized in 2 cases for severe adhesion.No complications occurred such as intra-abdominal bleeding,abscess or stump appendicitis.Conclusions：The application of monopolar electrocoagulation and mesoappendix ligation in LA is simple,safe and economical.It is advocated in units without ultrasound knife.