腹腔镜阑尾切除术中阑尾根部坏疽的处理

The processing mode of the root of appendix gangrene in laparoscopic appendectomy

目的探讨腹腔镜阑尾切除术中阑尾根部坏疽的处理方式。方法回顾莱芜钢铁集团有限公司医院2008年5月至2016年5月收治的83例腹腔镜阑尾切除术中阑尾根部坏疽患者的病历资料。术中使用腹腔镜器械、超声刀或内镜下切割吻合器(Endo-GIA)完成手术。结果 83例患者均成功完成腹腔镜手术,无中转开腹患者。手术时间45～95 min,平均(64.4±14.6)min;术后排气时间6～48h,平均(21.4±12.8)h;住院时间3～7d,平均(4±1.8)d;术后穿刺口感染7例(8.4%),腹腔残余感染2例(2.4%),粘连性肠梗阻1例(1.2%);无肠瘘发生。术后83例均治愈出院。结论腹腔镜阑尾切除术中阑尾根部坏疽的处理具体采用何种方式一般根据坏疽边缘距离盲肠的距离及坏疽程度决定:①单纯结扎或2枚hemolok夹闭:适用于阑尾坏疽近边缘距离盲肠5mm以上者。②单纯结扎+"8"字盲肠浆肌层缝合处理:适用于阑尾根部坏疽近边缘距离盲肠3～5mm者。③单纯结扎+荷包包埋处理:适用于阑尾根部坏疽距离盲肠3mm以内者。④Endo-GIA切割闭合器处理:适用于阑尾根部严重坏疽并穿孔者。

Objective To explore the processing mode of the root of appendix gangrene in laparoscopic appendectomy.Method The medical records of 83 cases of laparoscopic appendectomy in patients with intraoperative appendix gangrene in our hospital during May 2008 to May 2016 were retrospectively analyzed.The operation was performed by laparoscopic instruments,ultrasonic scalpel or Endo-GIA cutting and closing device.Results All of the 83 cases were successfully completed by lap aroscopy without laparotomy.The operation time was 45 to 95 min,with an average of(64.4±14.6)min;The postoperative exhaust time was 6 to 48 hours,with an average of(21.4±12.8)hours;The hospitalization time was 3 to 7 days,with an average of(4±1.8)days.7 patients had postoperative puncture infection(8.4%);2 patients showed abdominal residual infection(2.4%);adhesive intestinal obstruction occurred in 1 patients after surgery(1.2%);all patients had no intestinal fi stula.All 83 cases were cured and discharged.Conclusion In laparoscopic appendectomy,the treatment of gangrene at the ro ot of appendix depends on the distance from the edge of gangrene to the cecum and the degree of gangrene:①Simple ligation or two hemoloks clipping:This method is suitable for patients whose appendix gangrene margin is more than 5mm away from the cecum.②Simple ligation plus“8”suture of the serom uscular layer of the cecum:It is suitable for the patients whose appendix root gangrene margin is 3-5 mm away from the cecum.③Simple ligation and pocket embedding:It is suitable for those whose appendix root gangrene margin is less than 3 mm from the cecum.④Endo-GIA closure device:This method is suitable for severe gangrene or perforation at the root of appendix.