腹腔镜阑尾切除术的入路和戳孔选择策略

Strategy of operative approach and trocar position for laparoscopic appendectomy

目的探讨不同解剖位置的阑尾行腹腔镜阑尾切除术时选择入路和戳孔的技巧。方法回顾性分析204例腹腔镜阑尾切除术患者的临床资料,其中包括165例不同方式3孔法,22例经脐部单切口法和3孔法联合阑尾胆囊切除术17例。描述根据术中预探查结果选择手术入路及腹腔镜戳孔的技巧。结果经不同3孔法完成阑尾切除术腹腔镜成功率为95.15%,腹腔镜手术时间平均(41.5±7.4)min,住院时间平均(4.3±1.2)d。单切口腹腔镜成功率95.45%,联合手术组成功率88.4%。阑尾切除术与联合组住院时间与胃肠功能恢复时间两组比较,均无统计学意义(P>0.05)。结论腹腔镜阑尾切除术应重视术中预探查结果,灵活选择手术入路及戳孔,可降低手术难度,提高腹腔镜手术成功率。

Objective To investigate the techniques for choosing the operative approach and trocar position for laparoscopic appendectomy, in according to different anatomical location of appendix. Methods The data of 204 patients undergoing the laparoscopic appendectomy were analyzed retrospectively, including 165 with various styles of 3-incision, 22 of single umbilical incision, and 3-incision appendectomy combined with cholecystectomy in 17. According to the results of the pre-exploration during the operation,several techniques for selection of operative approach and trocar position were described. Results Laparoscopic appendectomy was performed with success rate of 95.15% in the 3-incision group, 95.45% in the single umbilical incision group,88.4% in the combined group. Operation time was 41.5＂4-7. 4 rain in the 3-incision group, and the average length of stay was 4.3-l-1.2 d, There was no statistical significance for the hospital stay and recovery time of gastrointestinal function in the appendectomy group and the combined group. Conclusion Preexploratory results should been pay high attention during the laparoscopic appendectomy, and the surgeon might choose flexibly operative approach and trocar position to reduce the difficulty of operation and to improve the success rate of laparoseopic surgery.