电视腹腔镜阑尾切除术45例报告

Television laparoscopic (LA) appendectomy for 45 cases

目的 探讨LA的适应证和治疗效果。方法 采用全麻、仰卧位、头低脚高并向左侧倾斜10°～15°,切口:脐下弧形10mm、脐水平右侧腹直肌外缘外侧2cm处5mm、脐与耻骨联合中点左侧2cm处5mm。结果 有44例获得成功,平均住院时间3.5d,随访3～7年(随访率90.0％),未见并发症。1例因大网膜包裹严重而中转开腹手术。结论 慢性阑尾炎、单纯性阑尾炎、化脓性阑尾炎和体征局限的坏死性阑尾炎是其适应证。术野清晰、能够全方位探查腹腔,创伤小、术后恢复快,切口感染率低、并发症少、腹部瘢痕细小是其优点。

Objective To study the indications & effect of appendectomy with LA. Methods The patients were arranged with general anesthesia and laid supine with higher head and lower foot. The body inclined to left in the degree of 10 - 15. There were 3 cutting holes on the abdomen (hole A, peritoneoscope hole, located under the navel. It was curve and about 10mm long. Hole B,chief operating hole,standing on the crossing of navel lever and 2mm to right outer edge of rectus abdominis muscle. Hole C,auxiliary operating hole,lied on the crossing of pubic symphysis and navel. Hole B and Hole C were both 5mm long). Results Forty-four cases were succeeded in the group of 45 applied LA. After operation, the patient's were hospitalized for 3.5 days on average. All patients were followed up from 3 to 7 years, showing good conditions without such complications as intestinal adhesion and obstruction, only one case failed because his appendix was seriously wrapped up by major momentum WTHZBConclusion Chronic appendicitis, acute simple appendicitis, pyogenic appendicitis and necrotic appendicitis can be considered as LA's absolute indications. The procedure possesses the advantages of obvious operation fields, exam the abdomen cavity completely,minimal trauma,recovery quickly,lower rate of incision infection,few complications,and slim operation scar.