腹腔镜下根部坏疽穿孔型阑尾炎的处理方法及决策

Laparoscopic root gangrene type perforated appendicitis treatment methods and decision-making

目的探讨腹腔镜下根部坏疽穿孔型阑尾炎的处理方法及决策。方法我院2013年5月-2016年5月共行55例根部坏疽穿孔型阑尾炎腹腔下阑尾切除术,其中试验组30例,行腹腔镜阑尾切除+根部间断缝合术;对照组25例,行腹腔镜下阑尾切除+根部结扎+荷包缝合术。结果试验组无腹腔感染、粪瘘等并发症发生,抗生素使用强度为(30.0±4.6)DDD,平均(6.0±1.2)d治愈出院,平均费用(8 120.00±675.00)元;对照组发生粪瘘4例,其中盆腔脓肿2例,抗生素使用强度为(50.0±7.3)DDD,平均住院天数(12.0±2.5)d,平均费用(12 352.00±1 175.00)元。2组手术时间、肛门排气、排便时间比较无统计学差异(P>0.05),抗生素使用强度、住院天数、住院费用比较有统计学差异(P<0.05)。结论采用腹腔镜下阑尾切除+根部间断缝合术治疗根部坏疽穿孔型阑尾炎,无明显并发症发生,抗生素使用强度低,住院天数短,平均费用低,安全有效,值得临床推广。

Objective To investigate the laparoscopic root gangrene type perforated appendicitis treatment methods and decision-making, continuous suture technique of laparoscopic appendix root treatment. Methods Retrospective analysis in May 2013 to May 2016, a total of 55 cases of root gangrene appendectomy under line type perforated appendicitis abdominal cavity, the experimental group 30 of whom underwent laparoscopic appendectomy ± root continuous suture technique, the control group, 25 cases line laparoscopic appendectomy ± root ligation ± pouch suture technique.Results the experimental group 30 cases, no complications, such as abdominal infection, fecal fistula antibiotic use strength to （30 ± 4.6） DDD, cured and discharged, an average of （6 ± 1.2） days on average （8 120.00 ± 675.00） yuan, the control group, 25 cases of fecal fistula occurred in 4 cases, including pelvic abscess 2 cases, antibiotic use strength of （50 ± 7.3）DDD, average hospitalization （ 12.0 ± 2.5） days, the average cost of （ 1 2352.00 ± 1 175.00） yuan.In operation time, anus exhaust, defecation time no statistical difference （P〉0.05）, the intensity of antibiotic use, hospitalization days, hospitalization expenses have statistical difference （P〈0.05）.Conclusion Type for root gangrenous perforated appendicitis, laparoscopic appendectomy ± root interrupted suture, no obvious complications, antibiotic use low intensity, short hospitalization days, the average cost is low, safe and effective, worthy of clinical promotion.