512例腹腔镜阑尾切除术的临床分析

Clinical analysis on 512 cases of laparoscopic appendectomy

目的 探讨腹腔镜阑尾切除术的方法及经验教训,以期提高手术水平.方法 回顾性分析2012年6月至2014年4月行腹腔镜阑尾切除术512例患者的临床资料,其中单纯性阑尾炎52例,化脓性阑尾炎306例,坏疽穿孔阑尾炎83例,慢性阑尾炎71例.合并阑尾周围脓肿20例,腹膜炎23例,附件肿物16例,有腹部手术史29例.结果 2例中转开腹,510例成功完成腹腔镜阑尾切除术.手术时间40～135 min,术中出血量5～ 85 ml,住院时间（4.2±0.2）d,住院费用（6 332.5±30.1）元.术后发生并发症13例,其中阑尾残端瘘2例,肠梗阻4例,戳孔感染2例,腹腔脓肿1例,肺部感染3例,误吸1例,无死亡病例.结论 腹腔镜阑尾切除术安全可行,具有术野清晰、探查范围广、创伤小、切口感染少等优点,可作为青年医师腹腔镜入门手术.

Objective To discuss the methods,experience and lessons of laparoscopic appendectomy to improve the curative effect.Methods The clinical data of 512 patients with appendicitis from June 2012 to April 2014 were reviewed retrospectively.Among them,52 cases of simple appendicitis,306 cases of suppurative,83 of were gangrenous or perforative and 71 cases of chronic appendicitis.Twenty cases were complicated with appendiceal abscess,23 cases were complicated with peritonitis and 16 cases were complicated with adnexal tumor.Twenty-nine cases had the history of abdominal operation.Results Among them,2 cases were converted to laparotomy,and other patients were successful completed operation.The operation time was 40-135 min.The amount of intraoperative bleeding was 5-85 ml.The hospitalization time was （4.2 ± 0.2） d.The hospitalization expenses was （6 332.5 ± 30.1） Yuan.Postoperative complications occurred in 13 cases.Among them,2 cases of appendix stump fistula,4 cases of intestinal obstruction,2 cases of incision infection,1 case of abdominal abscess,3 cases of pulmonary infection,and 1 case of mistake inhale.There was no death.Conclusions Laparoscopic appendectomy is safe and feasible.It has the advantages of clear operative field,broad exploration range,small trauma of operative tissues,low rate of incision infection and so on.It should be used as entry of laparoscopic operation for young doctors.