腹腔镜急性化脓性阑尾切除术中阑尾残端几种处理方式的经验和体会

A comparison of the several kinds of methods of laparoscopic appendectomy applied for the handling of appendix stump

目的比较腹腔镜急性化脓性阑尾切除术4种不同的阑尾残端处理方式的优劣性。方法选取我院2014年6月至2016年3月期间腹腔镜急性化脓性阑尾切除术患者共287例,根据阑尾残端处理方式分为4组:Hem-o-lock夹夹闭(Hemolock组77例)、单纯7号线双重结扎(双重结扎组103例)、单纯7号线双重结扎后加荷包缝合包埋(双重结扎加包埋组51例)、和单纯7号线缝扎组(56例)。比较4组的手术时间、术中出血量、排气时间、住院时间、严重并发症。结果所有4个组患者的手术过程顺利,无中转开腹,Hemolock组、双重结扎组、荷包缝合包埋组和缝扎组4组的手术时间、术中出血量、排气时间、住院时间、严重并发症方面比较的差异无统计学意义。结论对于腹腔镜手术技巧熟练的术者来说,阑尾根部几种处理方式的选择不影响患者的手术恢复以及并发症发生。

Objective To compare the superiority and inferiority the several methods of laparoscopic appendectomy(LA)applied for the handling of appendix stump.Methods A total of287patientsof laparoscopic acute suppurative appendectomy in the treatment of appendicitis,according to appendix stump processing mode were divided into four group:Hem?o?lock closure(group A,77cases),simple number7thread double ligation(group B,103cases),plus pouch suture embedding after simple number7thread ligation(group C,51cases),suture ligation(group d,56cases),compared the operation time,intraoperative blood loss,time of intestinal exhaust,hospital stay,serious complications with the three groups.Results Four groups of patients had a smooth operation and no transfer laparotomy.The comparison of time of operation and intraoperative blood loss and time of intestinal exhaust and length of hospital stay and serious complications of the three groups were not statistically significant.Conclusion For performer with excellent laparoscopic skill,the selection of methods of handling of appendix stump does not affect the recovery of operation and complication of patient.