免气腹腹腔镜技术在妊娠期阑尾炎中的应用

The application of gasless laparoscopic techniques in the treatment of appendicitis in pregnancy

目的：探讨免气腹腹腔镜技术治疗妊娠期阑尾炎的临床效果及其对妊娠结局的影响。方法：2010年1月至2014年12月为16例妊娠期阑尾炎患者施行免气腹腹腔镜阑尾切除术,观察分析患者手术时间、术中出血量、术后排气时间、住院时间、术后并发症,并随访至其分娩,观察母婴结局。结果：16例手术均在免气腹腹腔镜下完成,无一例中转开腹。手术时间30~80 min,平均（40±17）min;术中出血量5~20 ml,平均（11±3）ml;术后排气时间3~24 h,平均（8±5）h;住院4~10 d,平均（6±2）d。术后切口均甲级愈合。术后病理示：单纯性阑尾炎2例,化脓性阑尾炎12例,坏疽穿孔性阑尾炎2例。孕妇均随访至分娩,无一例流产、早产、死胎等并发症发生。结论：妊娠期行免气腹腹腔镜阑尾切除术对孕妇及胎儿均是安全、可行的,使妊娠期阑尾炎患者得到微创手术的机会。随着免气腹装置的不断改进,腹腔镜操作手术经验的累积,手术操作难度下降,手术时间缩短,值得推广应用。

Objective： To explore the clinical value of gasless laparoscopic techniques in the treatment of appendicitis in pregnancy and its effects on pregnancy outcome. Methods： From Jan. 2010 to Dec. 2014,16 pregnant women who suffered from appendicitis were treated with gasless laparoscopic appendectomy. The operation time,intraoperative blood loss,postoperative exhaust time,hospital stay and postoperative complications were observed and analyzed,and pregnant women were followed up to the childbirth in order to observe the outcome of the puerpera and her infant. Results： All 16 operations were successfully performed. None was converted to open surgery. The operation time was 30-80 min,the average was（ 40 ± 17） min. Intraoperative blood loss was 5-20 ml,the average was（ 11± 3） ml,postoperative exhaust time was 3-24 h,the average was（ 8 ± 5） h,the hospital stay was 4-10 d,the average was（ 6 ± 2） d.Postoperative incision healing was class A. Postoperative pathology showed that there were 2 cases of simple appendicitis,12 cases of suppurative appendicitis and 2 cases of gangrene perforating appendicitis. All pregnant women were followed up to delivery,no complications of miscarriage,premature birth and stillbirth occurred. Conclusions： Gasless laparoscopic technique in the treatment of appendicitis in pregnancy is safe and feasible,brings opportunity of mini-invasive operation for pregnant appendicitis patients. As the improvement of gasless instrument and accumulation of laparoscopic experience,the operative difficulty and time decrease,the technique is worthy to be popularized and applied in clinic.