无异物腹腔镜阑尾切除术治疗急症阑尾炎的临床体会

Experience of laparoscopic appendectomy without foreign bodies for acute appendicitis

目的:总结无异物腹腔镜阑尾切除术治疗急症阑尾炎的手术经验。方法:回顾分析2008年10月至2016年12月行无异物腹腔镜阑尾切除术治疗的1 494例急症阑尾炎患者的临床资料。采用常规三孔法施术,脐部建立10 mm观察孔,耻骨联合上方1~2 cm偏右为10 mm主操作孔,左下腹反麦氏点为5 mm副操作孔。必要时于左锁骨中线肋缘下另做第四个5 mm操作孔,以协助显露。术中采用双极电凝处理阑尾系膜后,用可吸收线圈套结扎阑尾根部。结果:1 474例顺利完成腹腔镜手术,74例逆行切除,29例采用四孔法施术;中转开腹20例,中转率1.3%。术中出血量平均(18.6±10.2)ml,手术时间平均(59.8±18.1)min,术后肠功能恢复时间平均(30.6±10.0)h,平均住院(5.9±2.1)d。术后发生并发症8例,其中左下腹戳孔血肿伴感染1例、迟发出血2例、残端瘘2例、膀胱破裂1例、腹壁脓肿2例,相应处理后均痊愈出院。结论:无异物腹腔镜阑尾切除术不仅具有创伤小、出血少、康复快、并发症少等优点,而且术后腹腔内无异物,是安全、可靠的阑尾切除术式。

Objective： To summarize the experience of laparoscopic appendectomy（ LA） without foreign bodies for acute appendicitis. Methods： The clinical data of 1 494 patients of acute appendicitis underwent LA without foreign bodies from Oct. 2008 to Dec. 2016 were analyzed retrospectively. The normal three-port method was used in the operation. The 10 mm observation port located at the umbilicus,the 10 mm main operation port located deviation to right at 1 ~ 2 cm above the pubic symphysis,the 5 mm auxiliary port at the anti-Mc Burney point on the left lower abdomen. The fourth operation port located at the left midclavicular line beneath costal margin as necessary. After the treatment for mesoappendix by bipolar electrocoagulation,the snare of absorbable sutures was used to ligate appendix root. Results： One thousand four hundred and seventy-four LA were performed successfully. 74 patients underwent reverse resection and 29 cases were treated by four-port. 20 cases were converted to open operation,and the conversion rate was 1. 3%. Intraoperative mean blood loss was（ 18. 6 ± 10. 2） ml. The mean operation time was（ 59. 8 ± 18. 1） min,and the mean time of recovery of postoperative intestinal function was（ 30. 6 ± 10. 0） h,and the mean hospital stay was（ 5. 9 ± 2. 1） d. Postoperative complications occurred in 8 cases,including 1 case of hematoma and infection of the port-site at the left lower abdominal wall,2 cases of delayed bleeding,2 cases of stump fistula,1 case of bladder rupture,and 2 cases of abdominal wall abscess. Patients were discharged from hospital after all complications were cured. Conclusions： The advantages of LA without foreign bodies are not only minimal invasion,little blood loss,quick recovery and few complications,but also no foreign bodies in abdominal cavity. This operation is safe and reliable.