改良荷包缝合法在腹腔镜阑尾切除术中的应用

Application of Improved Purse Suture in Laparoscopic Appendectomy

目的探讨改良荷包缝合法在腹腔镜阑尾切除术中的可行性及临床效果。方法 2012年1月~2014年12月我科在36例腹腔镜阑尾切除术中应用改良荷包缝合法,即间断环形缝合前半荷包与间断纵形(或斜形)缝合后半荷包合成一个荷包,包埋阑尾残端。结果术中无须改变持针方式和缝合习惯即可轻松完成腹腔镜下荷包缝合,36例LA均顺利收紧荷包缝线并包埋阑尾残端,无一例中转开腹。手术时间(70±20)min,术后住院时间(5±2)d。无荷包缝线撕裂浆肌层、阑尾残端漏或腹腔残余脓肿等并发症。36例术后半年通过电话随访,均无腹痛、腹胀等。结论改良荷包缝合法缝合荷包包埋阑尾残端具有操作方便,安全可靠的优点,避免应用传统方法缝合荷包给手术操作带来的诸多不便,降低因阑尾根部处理不满意而中转开腹的几率,值得推广应用。

Objective To explore the feasibility and clinical effect of improved purse suture in laparoscopic appendectomy. Methods The clinical data of 36 cases of laparoscopic appendectomy admitted from January 2012 to December 2014 were analyzed retrospectively. The patients were treated with the improved purse suture that synthesized two different half pouches to embed appendix stump. The one half of a pouch was given discontinuous annular suture, and the other half of a pouch was given discontinuous longitudinal （or oblique） suture. Results The operation was completed without the need of changing needle holding and suture habits. The purse suture was successfully tighten with the appendix stump embedded in the 36 cases. No conversion to open laparotomy was required. The operation time was （70 ＋ 20） rain, and the postoperative hospital stay was （5 ＋ 2） d. No rupture of sarcoplasmic layer, leakage of appendix stump, or abdominal residual abscess occurred. All cases were postoperatively followed up by telephone for half a year. No abdominal pain or abdominal distension was seen. Conclusion The improved purse suture for the treatment of the embedding appendix stump has advantages of convenient operation, safety and reliability, and can avoid the inconvenience caused by the traditional method of suture and reduce the incidence of conversion to open surgery, being worthy of popularization.