腹腔镜阑尾切除术683例临床分析

Clinical analysis of 683 patients with appendicitis treated by laparoscopic appendectomy

目的 总结腹腔镜阑尾切除术的临床应用经验.方法 回顾性分析行腹腔镜阑尾切除术治疗的阑尾炎患者683例的临床资料,其中慢性阑尾炎258例,急性阑尾炎425例（复杂性阑尾炎87例）.结果683例阑尾炎均经腹腔镜手术完成,无中转开腹手术,手术时间15～150 min,平均30 min,住院时间2～15 d,平均4 d.术后切口感染26例,腹腔脓肿3例,阑尾系膜出血1例,小肠瘘1例,阑尾残端瘘1例.683例术后随访2～12个月,平均6个月,无粘连性肠梗阻发生.结论 腹腔镜阑尾切除术具有创伤小、恢复时间短、术后疼痛轻、住院时间短和并发症发生率低等优点,值得临床推广应用.对于复杂性阑尾炎,要有丰富的经验和熟练规范的腔镜操作技术才能有效减少手术并发症的发生.

Objective To summarize the clinical experience of laparoscopic appendectomy（LA）.MethodsA retrospective analysis was conducted on the clinical data of 683 patients with appendicitis treated by LA,including 258 cases of chronic appendicitis,425 cases of acute appendicitis（87 cases of complicated appendicitis）.ResultsThe procedure was completed in all the patients without conversion to open surgery.The operation time was 30 min in average（15-150 min）.The average hospital stay was 4d （2-15d）.Postoperative complications included 26 cases of incision infection,3 cases of abdominal abscess,1 case of appendical mesenterium hemorrhage,1 case of small intestine fistula and 1 case of appendical stump fistula.The patients were followed up for 2 to 12 months with a mean of 6 months,during which no intestinal adhesive obstruction occurred.Conclusion LA is safe and effective for appendicitis,with advantages of minimal trauma,lighter pain,quicker recovery,shoter hospital stay,less complications and so on.For complicated appendicitis,the abundant surgical experience and proficient endoscopic technique are indispensable to reduce the occurrence of complications effectively.