腹腔镜阑尾切除术中盲肠憩室炎的处理

Treatment of Caecal Diverticulitis Found in the Course of Laparoscopic Appendectomy

目的探讨腹腔镜阑尾切除术中盲肠憩室炎的处理方式。方法我院2010年3月~2015年4月934例腹腔镜阑尾切除术中发现盲肠憩室炎16例,根据憩室大小及周围炎症程度行腹腔镜憩室切除术和开腹右半结肠切除术、回盲部切除、盲肠部分切除术及憩室切除术。结果腹腔镜憩室切除术3例;中转开腹手术13例:右半结肠切除术1例,回盲部切除3例,盲肠部分切除术6例,憩室切除术3例。手术时间25~90 min,平均45.3 min。术中出血量5~160 ml,平均31.6 ml;术后肠功能恢复时间1~5 d,平均3 d;术后住院时间3~8 d,平均7 d。16例术后随访10~48个月,平均36.3月,无腹痛、腹胀等发生。结论盲肠憩室炎的临床特征与急性阑尾炎相似,极易误诊,腹腔镜手术中要仔细探查,避免漏诊,根据术中具体情况决定手术方式。

Objective To discuss the treatment of caecal diverticulitis which were found in the course of laparoscopic appendectomy.Methods A total of 16 cases of caecal diverticulitis were found in the course of 934 laparoscopic appendectomy from March 2010 to April 2015 in our hospital.The surgical approaches included laparoscopic diverticulectomy, right colon resection, ileocecal resection, partial cecectomy, and caecal diverticulectomy.Results Three patients received laparoscopic caecal diverticulectomy.Thirteen patients were converted to open surgery.And 1 case underwent right colon resection, 3 cases underwent ileocecal resection, 6 cases underwent partial cecectomy, and 3 cases underwent caecal diverticulectomy.The operation time was 25-90 min （average, 45.3 min）, the intraoperative blood loss was 5-160 ml （average, 31.6 ml）, the postoperative bowel function recovery time was 1-5 d （average, 3 d）, and the postoperative hospital stay was 3-8 d （average, 7 d）.Sixteen cases were followed up for 10-48 months （average, 36.3 months）, and no postoperative complications were observed.Conclusions The clinical characters of caecal diverticulitis are similar to acute appendicitis.It＆#39;＆#39;s usually misdiagnosed as acute appendicitis, and should be explored carefully in laparoscopic appendectomy.Different surgical procedures should be chosen according to the condition of diverticulum.