阑尾根部穿孔合并急性化脓性腹膜炎的腹腔镜治疗(附51例报告)

Laparoscopic treatment of appendix root perforation complicated with acute suppurative peritonitis

目的探讨阑尾根部穿孔合并急性化脓性腹膜炎的腹腔镜处理方法。方法 2006年8月～2012年12月阑尾根部穿孔、急性化脓性腹膜炎的病例51例实施腹腔镜治疗。分析相关临床资料、疗效及术中处理方法。结果全组42例,31例采用全腹腔镜下治疗,2例出现戳孔感染,20例应用腹腔镜针对急性化脓性腹膜炎进行冲洗引流,处理完毕后经麦氏切口行阑尾切除术,其中1例出现脂肪液化,1例出现切口感染,所有病例均未出现肠漏、粘连性肠梗阻、腹腔感染、门静脉炎等并发症。结论在熟练开展腹腔镜阑尾切除术的基础上,阑尾根部穿孔不再是腹腔镜手术的禁忌,通过腹腔镜对腹腔内进行冲洗引流具有视野开阔、冲洗彻底等特点,治疗相关急性化脓性腹膜炎有独到优势。

Objective To discuss laparoscopic treatment of appendix root perforation complicated with acute suppurative peritonitis. Methods From August 2006 to December 2012,51 cases with appendix root perforation complicated with acute suppurative peritonitis received laparoscopic treatment. The related clinical data, curative effect and the management tech- niques were analyzed. Results Among all the 51 cases, 31 received total laparoscopic treatment,2 developed infection of poked holes, and 20 underwent washing and drainage with laparoscope directed to acute suppurative peritonitis, followed by ap- pendectomy through McBurney incision. One case developed fat liquefaction and another suffered from infection of incision. No complications such as intestinal leakage, adhesive ileus, abdominal infection and pylephlebitis occurred. Conclusion Based on the proficient laparoscopic appendectomy, appendix root perforation is no more a taboo to the laparoscopic surgery. The lapa- roscope has unique advantages in treating related acute suppurative peritonitis because it can rinse thoroughly and has a broad vision in the washing and drainage of enterocoelia.