硬膜外麻醉下无气腹腹腔镜阑尾切除术的临床分析

Clinical analysis of gasless laparoscopic appendectomy with epidural anesthesia

目的:探讨硬膜外麻醉下无气腹腹腔镜阑尾切除术的安全性及临床治疗效果。方法:选择2014年6月至2015年6月80例腹腔镜阑尾切除术患者作为研究对象,随机将其分为无气腹组与气腹组,每组40例。对比分析两组患者手术时间、术中出血量、术后下床活动时间、肛门排气时间、住院时间、住院费用等。结果:80例患者均顺利完成手术,手术成功率100%,无术后出血、肠道损伤、肠梗阻或中转开腹等并发症发生。两组手术时间、术中出血量差异无统计学意义(P>0.05),无气腹组术后下床活动时间、肛门排气时间、住院时间、住院费用优于气腹组,差异有统计学意义(P<0.001)。结论:硬膜外麻醉下无气腹腹腔镜阑尾切除术安全、有效,操作简单,对手术技巧要求较低,普通腹腔镜器械及部分开腹器械均可使用,适合在临床推广应用。

Objective： To investigate the safety and clinical effect of gasless laparoscopic appendectomy with epidural anesthesia. Methods： Eighty laparoscopic appendectomy patients from Jun. 2014 to Jun. 2015 were randomly divided into gasless group（ n =40） and pneumoperitoneum group（ n = 40） as research subjects. The operation time,intraoperative blood loss,postoperative ambulation time,flatus time,hospital stay,hospitalization cost of the two groups were compared and analyzed. Results： Surgeries for 80 patients were completed with 100% success rate,without complications such as postoperative bleeding,intestinal injury,intestinal obstruction or conversion to laparotomy. There were no significant differences in the operation time,intraoperative blood loss between the two groups,but the postoperative ambulation time,flatus time,hospital stay and hospitalization cost in gasless group were much better than those in pneumoperitoneum group,the differences were statistically significant（ P 〈 0. 001）. Conclusions： Gasless laparoscopic appendectomy with epidural anesthesia is safe,effective,simple,and suitable for clinical application. Ordinary laparoscopic instruments and partial laparotomy instruments can be used in this procedure which requires less operative technique.