Hem-o-lok与阑尾缝扎荷包缝合结扎在经腹腔镜阑尾切除阑尾残端处理中的应用效果比较

Comparison of the application effects of Hem-o-lok and appendix transfixion and purse suture ligation in the treatment of appendix stump by laparoscopic appendectomy

目的研究比较经腹腔镜行阑尾切除术中阑尾残端上Hem-o-lok结扎夹夹闭与阑尾残端缝扎及荷包包埋的临床效果。方法选取2016年1月～2018年1月在我院行腹腔镜阑尾切除术治疗的100例阑尾炎患者作为研究对象,应用随机数字表法将患者随机分为两组,每组各50例。夹闭组患者在腹腔镜阑尾切除术中采用Hem-o-lok结扎夹对阑尾残端进行夹闭,荷包缝合组患者在腹腔镜阑尾切除术中对阑尾残端进行缝扎、荷包缝合包埋。比较两组患者的手术情况、术后疼痛评分、术后并发症发生情况、术后恢复情况、免疫功能指标。结果在手术情况方面,荷包缝合组患者的手术时间长于夹闭组,差异有统计学意义(P<0.05),而两组患者的术中出血量比较,差异无统计学意义(P>0.05)。在术后疼痛评分方面,两组患者术后8、12、24、48 h的疼痛评分比较,差异均无统计学意义(P>0.05)。在术后并发症发生情况方面,荷包缝合组患者的术后并发症总发生率为4.00%,夹闭组患者的术后并发症总发生率为18.00%,荷包缝合组患者的术后并发症总发生率低于夹闭组,差异有统计学意义(P<0.05)。在术后恢复情况方面,荷包缝合组患者的肛门排气恢复时间、住院时间均短于夹闭组,差异有统计学意义(P<0.05)。在免疫功能指标方面,两组患者术后的CD3+、CD4/CD8均低于术前,差异有统计学意义(P<0.05),而荷包缝合组的CD3+、CD4/CD8高于夹闭组,差异有统计学意义(P<0.05)。结论在腹腔镜阑尾切除术中,Hem-o-lok结扎夹夹闭、荷包缝合包埋均可对阑尾残端予以有效处理,具有其各自优势,Hem-o-lok结扎夹夹闭的手术时间相对较短,操作简便,而荷包缝合包埋的术后并发症较少,术后恢复速度较快,临床上可根据患者具体需求合理选择相应的阑尾残端处理方法。

Objective To compare the clinical effects of Hem-o-lok ligature clamp clamping and appendix stump suture and purse embedding in appendix stump by laparoscopic appendectomy.Methods A total of 100 cases of appendicitis patients who underwent laparoscopic appendectomy in our hospital from January 2016 to January 2018 were selected as the research objects.Patients were randomly divided into 2 groups by random number table method,50 cases in each group.The appendix stump was clamped with Hem-o-lok ligature clamp was used in laparoscopic appendectomy for patients in the clamping group,and Hem-o-lok ligation clip was used in patients in the purse suture group for clamping appendectomy the appendix stump was sutured,purse was sutured and embedded was used in laparoscopic appendectomy for patients in the purse suture group.The operation condition,postoperative pain score,postoperative complications,postoperative recovery,and immune function index were compared between the two groups.Results In terms of the surgery,the surgery time in the purse suture group was longer than that in the clamping group,the difference was statistically significant(P<0.05).There was no statistically significant difference in the amount of intraoperative blood loss between the two groups(P>0.05).In terms of postoperative pain scores,there were no statistically significant differences in pain scores between the two groups at 8,12,24,and 48 h after surgery(P>0.05).In terms of postoperative complications,the total incidence of postoperative complications of purse suture group was 4.00%,and the total incidence of postoperative complications in the clamping group was 18.00%.The total incidence of postoperative complications of postoperative complications in the purse suture group was lower than that in the clamping group,the difference was statistically significant(P<0.05).In terms of postoperative recovery,the anal exhaust recovery time and length of hospital stay in the purse suture group were both shorter than those in the clamping group,the differences were statistically significant(P<0.05).In terms of immune function indexes,the CD3^+,CD4/CD8 of the two groups after surgery were lower than those before surgery,the differences were statistically significant(P<0.05),and the CD3^+,CD4/CD8 in the purse suture group were higher than that in the clamping group,the differences were statistically significant(P<0.05).Conclusion In laparoscopic appendectomy,Hem-o-lok ligature clamping and purse suture embedding can effectively treat the appendix stump,which has their own advantages.The surgery time of the Hem-o-lok ligature clamping is relatively short and easy to operate.The postoperative complications of purse suture embedding are less,and the postoperative recovery is faster.Clinically,the corresponding appendix stump treatment method can be reasonably selected according to the specific needs of the patient.