腹腔镜手术治疗急性阑尾炎并穿孔256例报告

The clinical analysis of 256 cases of laparoscopic appendectomy for acute appendicitis complicated with perforation

目的:探讨腹腔镜阑尾切除术治疗急性阑尾炎并穿孔的手术方法、指征、并发症及效果。方法:回顾分析2006年7月至2010年6月为256例急性阑尾炎并穿孔患者行腹腔镜手术的临床资料。结果:256例手术均获成功,无一例中转开腹。手术时间35～110 min,平均55 min,术中出血量5～20 ml,术后排气时间平均19.5 h,住院4～7 d,平均5 d,患者均治愈出院。术后2例左下腹切口发生感染,经换药6 d后痊愈,余均未发生粘连性肠梗阻、腹腔感染、盆腔脓肿及残端漏等并发症。结论:急性阑尾炎并穿孔行腹腔镜手术安全可行,术者具有熟练的腹腔镜操作技巧及丰富的手术经验,几乎所有类型的阑尾炎均可行腹腔镜手术,具有并发症少、患者创伤小、疗效好、康复快、住院时间短等优点。

Objective：To investigate the operative method,indication,complications and effect of laparoscopic appendectomy in treatment of acute appendicitis complicated with perforation.Methods：The clinical data of 256 patients who suffered from acute appendicitis complicated with perforation and underwent laparoscopy from Jul.2006 to Jun.2010 was retrospectively analyzed.Results：All 256 laparoscopic operations were successfully performed without conversion to open surgery.The operative time was 35-110 min（mean 55 min）,the intraoperative blood loss was 5-20 ml.The postoperative exhaust time was 19.5 h,hospital stay was 4-7 d（mean 5 d）.All these patients healed.Port-site infection was found in 2 cases and cured by dressing change 6 d later.No other complications were found such as adhesive intestinal obstruction,the abdominal cavity infection,the pelvic cavity abscess,or appendix stump leakage.Conclusions：Laparoscopic appendectomy is safe,feasible and mini-invasive,with advantages of less complications,better effect,quicker recovery,and shorter hospital stay.For a skilled and proficient operator,it is suitable for almost all types of appendicitis.