Modified technical protocol for single-port laparoscopic appendectomy using needle-type grasping forceps for acute simple appendicitis:A case report

BACKGROUND Because of the mild inflammatory status in acute uncomplicated appendicitis,our team developed a novel technical protocol for single-port laparoscopic appendec-tomy using needle-type grasping forceps(SLAN)and achieved positive clinical outcomes.However,the intraoperative procedure lacked stability and fluency due to a series of problems highlighted by the small incision design of the proto-col(only 1 cm long).Therefore,there is a growing clinical demand to further opti-mize the SLAN protocol.CASE SUMMARY An adult male patient was admitted for persistent right lower abdominal pain with preoperative computed tomography findings suggestive of appendicitis accompanied by localized peritonitis.A modified technical protocol for SLAN based on minimally invasive surgical principles was used,and the patient was confirmed to have acute simple appendicitis by postoperative pathological ana-lysis.Postoperative recovery was uneventful,and no postoperative complications,such as incision infection or severe incision pain,were observed.The patient was discharged successfully on postoperative day 2.CONCLUSION The modified technical protocol of SLAN may be a new minimally invasive surgical alternative for patients with acute simple appendicitis.

Effects of oral probiotics on inflammation and intestinal function in adult patients after appendectomy:Randomized controlled trial

BACKGROUND Appendectomy is an acute abdominal surgery that is often accompanied by severe abdominal inflammation.Oral probiotics are one of the postoperative treatments for rapid rehabilitation.However,there is a lack of prospective studies on this topic after appendectomy.AIM To investigate whether the postoperative probiotics can modulate the inflammatory response and restore intestinal function in patients following appendectomy.METHODS This was a prospective,randomized trial.A total of 60 emergency patients were randomly divided into a control group(n=30)and a probiotic group(n=30).Patients in the control group started to drink some water the first day after surgery,and those in the probiotic group were given water supplemented with Bacillus licheniformis capsules for 5 consecutive days postsurgery.The indices of inflammation and postoperative conditions were recorded,and the data were analyzed with RStudio 4.3.2 software.RESULTS A total of 60 participants were included.Compared with those in the control group,the C-reactive protein(CRP),interleukin 6 and procalcitonin(PCT)levels were significantly lower in the probiotic group at 2 d after surgery(P=2.224e-05,P=0.037,and P=0.002,respectively,all P<0.05).This trend persisted at day 5 post-surgery,with CRP and PCT levels remaining significantly lower in the probiotic group(P=0.001 and P=0.043,both P<0.05).Furthermore,probiotics0.028,both P<0.05).CONCLUSION Postoperative oral administration of probiotics may modulate the gut microbiota,benefit the recovery of the early inflammatory response,and subsequently enhance recovery after appendectomy.

Enhanced recovery after surgery pathways for patients undergoing laparoscopic appendectomy:A systematic review and meta-analysis

Objective:To compare the benefits of enhanced recovery after surgery(ERAS)pathways with traditional pathways for adult patients undergoing laparoscopic appendectomy.Methods:We looked for publications using the keywords“Enhanced Recovery After Surgery,”“Fast-track Surgery,”“Laparoscopic Appendectomy,”and“Laparoscopic Appendicectomy”in PubMed/Medline,Embase,and the Cochrane library.Operative time,lesser length of stay,oral intake timing,readmission rate,pain/satisfaction levels,readmission rate,and surgical site infections were recorded and analyzed.Results:A total of 95 articles from registers and 161 articles from databases were identified.Three eligible studies were included.The ERAS pathways had a lesser length of stay[Z=2.06,MD=−1.05,95%CI=(−2.04,−0.05),P=0.04]and an earlier start to postoperative feeds[Z=6.22,MD=−267.49,95%CI=(−351.80,−183.19),P<001].Conclusions:ERAS pathways have a shorter length of stay and earlier postoperative feed initiation for adult patients undergoing laparoscopic appendectomy compared with standard care.Both approaches have similar operative time,surgical site infection incidence,and readmission rate.Clinical registration:This review is registered with INPLASY202280005.

Reduced port surgery for appendectomy:Early experience and surgical technique

AIM: To evaluate our experience and surgical technique of laparoscopic appendectomy via reduced port surgery(LARPS). METHODS: Sixteen patients(8 men and 8 women; median age: 31.0 years) who underwent LARPS between November 2009 and May 2012 were included in the present study. We performed LARPS, in which access devices were inserted through an umbilical skin incision with 1 additional skin incision in the left lower abdomen. After setting access devices, pneumoperitoneum was maintained at 10 mmH g using CO2 and a 3 mm trocar was positioned(or direct puncture was performed by the Endo Relief system) under laparoscopic guidance. The mesoappendix was dissected using an ultrasonically activated device. After mesoappendix dissection, ligation was performed near the appendix base and the appendix was dissected using an ultrasonically activated device. The appendix was then removed. At the end of surgery, we administered local anesthesia with ropivacaine 1%(10 mL) for the skin incisions. The outcomes were evaluated in terms of operation time, intraoperative blood loss, length of postoperative hospital stay and surgical complications. RESULTS: Our surgical procedure allowed operators to use instruments as in conventional laparoscopic appendectomy. The basic principle of triangulation of instrumentation was maintained to some degree. LARPS was performed in 9 patients with catarrhal appendicitis, 5 with phlegmonous appendicitis, and 2 with gangrenous appendicitis. The median surgery time was 60 min and the median intraoperative blood loss was 1.2 mL. The median length of postoperative hospitalization was 4 d. There were no conversions to open surgery, no operation-related complications or mortality. CONCLUSION: Our experience and surgical technique suggest that LARPS is a safe and feasible procedure for patients with appendicitis.

A comparison of outcomes between laparoscopic and robotic appendectomy among ACS-NSQIP hospitals

Objective:Robotic general surgery remains controversial,with some employing the technology for common laparoscopic procedures such as appendectomies.Very few studies have compared robotic appendectomy(RA)to existing techniques,partly due to the relative scarcity of data.The purpose of this study was to compare outcomes for RA versus laparoscopic appendectomy(LA).Methods:This retrospective cohort study evaluated procedural specific databases of the American Col-lege of Surgeons National Surgical Quality Improvement Program(ACS-NSQIP)for appendectomy be-tween January 2016 and December 2019 and included all available cases at the time of analysis(June 2021).Demographic and surgical outcomes including composite 30-day complications,specific com-plications,and length of operation were analyzed using a univariate analysis.Results:In total,there were 52,559 appendectomies in the NSQIP database between 2016 and 2019.Analysis was restricted to those who underwent minimally invasive approaches.In total,49,850 patients were included in the analysis.Of those,49,800 patients underwent LA,and 50 patients underwent RA.Participants who underwent RA were older(35.8±4.5 y vs.23.0±0.2 y,p<0.01).There was no dif-ference in the total number of comorbidities(92.0%vs.73.4%,p=0.32)or the severity of appendicitis(p>0.90)between RA and LA cases.RA had a longer median operation time(71.0 min vs.46.0 min,p<0.01)but a shorter postoperative stay(0.7 d vs.1.3 d,p<0.01).There was no difference in the frequency of readmission likely related to procedure(4.0%vs.3.0%,p=0.88)or complications(18.0%vs.23.8%,p=0.88);however,RA was associated with increased 30-day mortality(2.0%vs.<0.1%,p<0.01)compared to LA.Conclusion:Our results demonstrated that LA and RA had a similar frequency and profile of complica-tions.Robotic procedures took longer but resulted in shorter postoperative stays.Our study revealed that RA constituted a mere 0.1%of all cases,with only 50% showing pathology consistent with appendicitis,despite 92.2%of LA cases presenting with the condition.Despite our findings of RA offering some benefit,more research is necessary,particularly regarding outcomes and value delivery.

腹腔镜手术和开腹手术治疗急性阑尾炎的疗效对比分析

目的 对比腹腔镜手术和开放式手术治疗急性阑尾炎的疗效。方法 选取2021年1月—2023年4月本院普外科收治的急性阑尾炎患者180例为研究对象,采用随机分组方法将入组患者随机分为试验组(n=90)和对照组(n=90)。试验组采取腹腔镜阑尾切除术,对照组采取开腹阑尾切除术。记录两组患者手术时长、术后首次排气时间、抗菌药物应用时长、术后住院时间、术后疼痛等主要观察指标,以及切口感染、肠粘连、腹腔脓肿等术后并发症发生率,经分析后对比两组手术方式疗效。结果 试验组患者的手术时长、术后首次排气时间、抗菌药物应用时长、术后住院时间短于对照组(P<0.05);术后疼痛程度低于对照组(P<0.05);术后并发症的总发生率低于对照组(P<0.05)。结论 腹腔镜阑尾切除术治疗急性阑尾炎患者,能有效缩短手术时长、住院时间,减轻患者术后疼痛,患者术后胃肠道功能恢复较早,并发症发生率低,安全性更高。

清热祛湿导滞汤辅助腹腔镜阑尾切除手术对湿热瘀滞型患者胃肠功能的影响

目的研究分析清热祛湿导滞汤结合腹腔镜阑尾切除术对湿热瘀滞型患者的影响。方法选取2021年1月—2023年6月本院收治的150例湿热瘀滞型急性阑尾炎患者为样本,按照抛硬币法将其分为对照组和试验组,每组75例。对照组采用常规治疗法,试验组在对照组的基础上加用清热祛湿导滞汤治疗。对两组中医证候积分、胃肠功能相关指标进行对比分析。结果治疗后,试验组中医证候积分低于对照组,差异显著,有统计学意义(P<0.05);与对照组比,试验组术后排气时间、肠鸣音恢复时间更短,差异显著,有统计学意义(P<0.05);试验组胃肠功能障碍发生率少于对照组,差异显著,有统计学意义(P<0.05)。结论清热祛湿导滞汤辅助腹腔镜阑尾切除术能促进湿热瘀滞型患者胃肠功能恢复,值得临床推广。

穿孔坏疽阑尾炎患者行开腹和腹腔镜下阑尾炎手术治疗的效果分析

目的 探讨穿孔坏疽阑尾炎患者行开腹和腹腔镜下阑尾炎手术治疗的效果。方法 84例穿孔坏疽阑尾炎患者,随机分为观察组与对照组,各42例。对照组使用常规开腹手术治疗,观察组使用腹腔镜下阑尾炎手术治疗。比较两组各项手术指标、并发症发生情况、炎症及应激反应指标、世界卫生组织生存质量量表(WHOQOL-100)评分。结果 观察组手术时间(58.67±6.20)min、术后排气时间(25.16±5.42)h、下床活动时间(8.31±2.04)h、住院时间(6.21±1.68)d均短于对照组的(71.35±8.48)min、(52.37±7.89)h、(24.84±4.03)h、(12.57±3.03)d,术中出血量(24.38±4.16)ml少于对照组的(64.73±9.51)ml,术后1 d的视觉模拟评分法(VAS)评分(2.42±0.65)分低于对照组的(5.18±1.02)分(P<0.05)。观察组并发症发生率4.76%低于对照组的23.81%(P<0.05)。观察组术后24 h的降钙素原(PCT)(0.62±0.20)μg/L、C反应蛋白(CRP)(22.91±4.35)mg/L、肿瘤坏死因子-α(TNF-α)(47.83±11.76)μg/L、皮质醇(Cor)(54.64±7.72)μg/dl均低于对照组的(1.39±0.24)μg/L、(31.83±5.72)mg/L、(75.14±14.59)μg/L、(126.43±13.51)μg/dl(P<0.05)。观察组术后1周的生理领域、独立性领域、社会关系领域、心理领域、环境领域评分分别为(4.03±0.22)、(4.10±0.24)、(4.14±0.23)、(4.12±0.28)、(4.17±0.29)分,均高于对照组的(2.97±0.28)、(3.01±0.27)、(3.04±0.25)、(2.95±0.24)、(3.06±0.25)分(P<0.05)。结论 穿孔坏疽阑尾炎患者行腹腔镜下阑尾炎手术治疗的效果更好,术后炎症及应激反应程度轻,恢复快,并发症发生率低,有助于快速提高生活质量,具有积极的临床意义。

小切口与腹腔镜阑尾切除术对急性阑尾炎患者围术期指标、疼痛及并发症的影响研究

探究小切口与腹腔镜阑尾切除术对急性阑尾炎患者围术期指标、疼痛及并发症的影响。选取2022年1月—2022年12月期间清镇市流长苗族乡中心卫生院收治的80例急性阑尾炎手术患者为研究对象,依照随机数字表法将患者分为对照组、实验组两组,每组各40例患者。对照组患者采取小切口阑尾切除手术方式治疗,实验组采用腹腔镜阑尾切除手术方式治疗。将两组患者围术期指标、疼痛情况、术后并发症情况进行比较分析。比较两组患者围术期指标,实验组患者术中出血量更少,手术耗时更短,术后首次排气、下床所用时间更短,出院时间更早(P<0.05);比较两组患者疼痛情况,实验组患者于出手术室时、术后6h、12h、24h、48h期间疼痛评分均低于对照组患者,疼痛感更弱(P<0.05);比较两组患者术后并发症发生率,实验组并发症发生率显著低于对照组患者(P<0.05)。研究发现,将腹腔镜阑尾切除术应用在急性阑尾炎的治疗中,可提升患者围术期指标,促进患者恢复,缓解患者疼痛感,降低并发症的发生率。

Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy

Acute appendicitis(AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy(LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Nonoperative management of AA may be tolerated only in children. Postoperative complications increase according to the patient's factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon's skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner(i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.

Transumbilical laparoscopic-assisted appendectomy in children: Clinical and surgical outcomes

The aim of this paper is to present and describe tran-sumbilical laparoscopic-assisted appendectomy in chil-dren, focusing on its technical aspects and clinical andsurgical outcomes. The surgical charts of all patientsaged between 0 and 14 years treated with transumbili-cal laparoscopic-assisted appendectomy admitted tothe authors' institution from January 2009 to Septem-ber 2013 with a diagnosis of suspected appendicitis fol-lowing clinical, laboratory and ultrasound findings werereviewed. Operating time, intraoperative findings, needfor conversion or for additional trocars, and surgicacomplications were reported. During the study period,120 patients aged between 6 and 14 years(mean age:9.9 years), 73 females(61%) and 47 males(39%),were treated with transumbilical laparoscopic-assistedappendectomy. There were 37 cases of hyperemicappendicitis(subserosal and retrocecal), 74 cases ofphlegmonous appendicitis and 9 cases of perforatedgangrenous appendicitis. It was not possible to estab-lish a correlation between grade of appendicitis andmean operating time(P > 0.05). Eleven cases(9%)needed the use of one additional trocar, while 8 pa-tients(6%) required conversion to the standard laparo-scopic technique with the use of two additional trocars. No patient was converted to the open technique. Tran-sumbilical laparoscopic-assisted appendectomy is a safe technique in children and it could be used by surgeons who want to approach other minimally invasive tech-niques.

Prior appendectomy and the phenotype and course of Crohn's disease

AIM： To determine whether prior appendectomy modifies the phenotype and severity of Crohn＇s disease. METHODS： Appendectomy status and smoking habits were specified by direct interview in 2838 patients consecutively seen between 1995 and 2004. Occurrence of complications and therapeutic needs were reviewed retrospectively. Additionally, annual disease activity was assessed prospectively between 1995 and 2004 in patients who had not had ileocecal resection and of a matched control group. RESULTS： Compared to 1770 non-appendectomized patients, appendectomized patients more than 5 years before Crohn＇s disease diagnosis （n=716） were more often females, smokers, with ileal disease. Cox regression showed that prior appendectomy was positively related to the risk of intestinal stricture （adjusted hazard ratio, 1.24; 95% confidence interval, 1.13 to 1.36; P=0.02） and inversely related to the risk of perianal fistulization （adjusted hazard ratio, 0.75; 95% confidence interval, 0.68 to 0.83; P=0.002）. No difference was observed between the two groups regarding the therapeutic needs, except for an increased risk of surgery in appendectomized patients, attributable to the increased prevalence of ileal disease. Between 1995 and 2004, Crohn＇s disease was active during 50% of years in appendectomized patients （1318 out of 2637 patientyears） and 51% in non-appendectomized patients （1454 out of 2841 patient-years; NS）. CONCLUSION： Prior appendectomy is associated with a more proximal disease and has an increased risk of stricture and a lesser risk of anal fistulization. However, the severity of the disease is unaffected.

Patient and physician perception of natural orifice transluminal endoscopic appendectomy

AIM:To investigate perception of natural orifice transluminal endoscopic surgery(NOTES)as a potential technique for appendectomy.METHODS:One hundred patients undergoing endoscopy and 100 physicians were given a questionnaire describing in detail the techniques of NOTES and laparoscopic appendectomy.They were asked about the reasons for their preference,choice of orifice,and extent of complication risk they were willing to accept.RESULTS:Fifty patients(50%)and only 21 physicians(21%)preferred NOTES(P<0.001).Patients had previously heard of NOTES less frequently(7%vs73%,P<0.001)and had undergone endoscopy more frequently(88%vs 36%,P<0.001)than physicians.Absence of hernia was the most common reason for NOTES preference in physicians(80%vs 44%,P= 0.003),whereas reduced pain was the most common reason in patients(66%vs 52%).Physicians were more likely to refuse NOTES as a novel and unsure technique(P<0.001)and having an increased risk of infection(P<0.001).The preferred access site in both groups was colon followed by stomach,with vagina being rarely preferred.In multivariable modeling,those with high-school education[odds ratio(OR):2.68,95% confidence interval(CI):1.23-5.83]and prior colonoscopy(OR:2.10,95%CI:1.05-4.19)were more likely to prefer NOTES over laparoscopic appendectomy.There was a steep decline in NOTES preference with increased rate of procedural complications.Male patients were more likely to consent to their wives vaginal NOTES appendectomy than male physicians(P=0.02).CONCLUSION:The preference of NOTES for appendectomy was greater in patients than physicians and was related to reduced pain and absence of hernia rather than lack of scarring.

Laparoscopic surgery:A qualified systematic review

AIM: To review current applications of the laparoscopic surgery while highlighting the standard procedures across different fields.METHODS: A comprehensive search was undertaken using the Pub Med Advanced Search Builder. A total of 321 articles were found in this search. The following criteria had to be met for the publication to be selected: Review article, randomized controlled trials, or metaanalyses discussing the subject of laparoscopic surgery. In addition, publications were hand-searched in the Cochrane database and the high-impact journals. A total of 82 of the findings were included according to matching the inclusion criteria. Overall, 403 full-text articles were reviewed. Of these, 218 were excluded due to not matching the inclusion criteria. RESULTS: A total of 185 relevant articles were identified matching the search criteria for an overview of the current literature on the laparoscopic surgery. Articles covered the period from the first laparoscopic application through its tremendous advancement over the last several years. Overall, the biggest advantage of the procedure has been minimizing trauma to the abdominal wall compared with open surgery. In the case of cholecystectomy, fundoplication, and adrenalectomy, the procedure has become the gold standard without being proven as a superior technique over the open surgery in randomized controlled trials. Faster recovery, reduced hospital stay, and a quicker return to normal activities are the most evident advantages of the laparoscopic surgery. Positive outcomes, efficiency, a lower rate of wound infections, and reduction in the perioperative morbidity of minimally invasive procedures have been shown in most indications. CONCLUSION: Improvements in surgical training and developments in instruments, imaging, and surgical techniques have greatly increased safety and feasibility of the laparoscopic surgical procedures.

Outcomes of Single-Incision Laparoscopic Appendectomy at a Single Center

Background and Objectives: Recently, single-incision laparoscopic surgery has been popular for minimally invasive surgery and cosmetic improvement. We studied outcomes of single-incision laparoscopic appendectomy (SILA) in accordance with our strategy for acute appendicitis. Methods: Clinical outcomes were revealed in each of nine emergency SILA (e-SILA) cases and eight interval SILA (i-SILA) cases performed for the treatment of acute appendicitis between September 2010 and August 2012 at our hospital. Results: The male to female ratio was 6:3 for e-SILA and 5:3 for i-SILA cases. Mean ages were 33.1 ± 17.8 years and 41 ± 21.6 years for e-SILA and i-SILA, respectively. The pretreatment white blood cell (WBC) count and C-reactive protein (CRP) levels were 14960 ± 4080/μL and 1.4 ± 2.3 mg/d, respectively, for e-SILA and 12657 ± 4290/μL and 6.7 ± 8.3 mg/d, respectively, for i-SILA. The maximum transverse diameter of appendix was 12.6 ± 3.5 mm for e-SILA and 11.6 ± 3.5 mm for i-SILA. Appendiceal abscesses were encountered in one (11%) e-SILA and three (38%) i-SILA cases. Perforation of the appendix at operation occurred in two (22%) e-SILA cases and no i-SILA cases. Generalized peritonitis occurred in 4 (44%) e-SILA cases but in none of the i-SILA cases. The postoperative hospital stay was 5.3 days for e-SILA, 2.7 days for i-SILA. Conversion to laparotomy was not required in either group. One additional trocar was needed for an e-SILA case, and paralytic ileus occurred as a postoperative complication in one e-SILA case. Conclusion: The outcomes of SILA performed under our strategy were acceptable and useful without major postoperative complications.

腹腔镜下阑尾切除术与开腹手术治疗穿孔性阑尾炎的疗效分析

目的分析腹腔镜下阑尾切除术与开腹手术治疗穿孔性阑尾炎的疗效。方法60例穿孔性阑尾炎患者,随机分为对照组及试验组,每组30例。对照组采取常规开腹手术治疗,试验组采取腹腔镜下阑尾切除术治疗。比较两组肠鸣音恢复时间、自拟腹胀量表评分、腹痛程度评分、恶心程度评分、并发症评分及术后切口感染评分。结果试验组患者肠鸣音恢复时间(27.50±3.21)h短于对照组的(33.80±3.18)h,自拟腹胀量表评分(1.40±0.32)分、腹痛程度评分(3.50±0.70)分低于对照组的(2.90±0.31)、(5.50±0.70)分,差异有统计学意义(P<0.05)。试验组患者恶心程度评分(3.70±0.12)分、并发症评分(2.50±0.11)分、术后切口感染评分(4.20±0.17)分均低于对照组的(5.90±0.11)、(4.50±0.24)、(3.20±0.19)分,差异有统计学意义(P<0.05)。结论腹腔镜下阑尾切除术对穿孔性阑尾炎患者的治疗效果显著,值得推广。

快速康复外科理念护理在腹腔镜阑尾切除术患者中的应用效果

目的:观察快速康复外科(FTS)理念护理在腹腔镜阑尾切除术患者中的应用效果。方法:选取2019年1月至2020年12月该院收治的110例行腹腔镜阑尾切除术患者进行前瞻性研究,按随机数字表法将其分为对照组和观察组各55例。对照组采用常规护理,观察组采用FTS理念护理,比较两组康复指标(首次排气时间、首次排便时间、首次下床活动时间以及住院时间)水平、并发症发生率和护理前后生命质量[健康状况调查简表(SF-36)]评分。结果:观察组首次排气时间、首次排便时间、首次下床活动时间以及住院时间均短于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为3.64%(2/55),低于对照组的14.55%(8/55),差异有统计学意义(P<0.05);护理后,两组躯体疼痛、生理职能、精神健康、生理功能、一般健康状况、活力、社会功能、情感职能等SF-36评分均高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:FTS理念护理应用于腹腔镜阑尾切除术患者有助于缩短术后康复时间,降低并发症发生率,以及提高患者生命质量,效果优于常规护理。

探讨日间腹腔镜阑尾切除术的推广模式

目的:基于单中心临床实践,探讨日间腹腔镜阑尾切除术(DCLA)的推广模式,初步验证此模式的安全性与有效性。方法:前瞻性分析2022年2月22日至2022年9月30日连续收治的97例腹腔镜阑尾切除术患者的临床资料,不设置入选标准,患者均接受加速康复外科“五大核心要素”处理,并自动进入DCLA管理,依据术后恢复情况决定是否终止DCLA。结果:81例最终符合DCLA标准,占83.51%。术后通气时间平均(10.37±1.85)h,住院(1.42±0.50)d。术后30 d随访,发生切口感染1例(1.23%),无腹腔感染、再次住院、再次手术、严重并发症及死亡病例。结论:加速康复外科核心措施适于腹腔镜阑尾切除术,通过术前评估后施行的腹腔镜阑尾切除术可认为符合DCLA入选标准,将判定DCLA是否终止的依据放在术后结局方面,这一模式安全、可行,可减少外科医生行DCLA时的困扰,提高DCLA的执行率。

舒适护理在急性阑尾手术治疗过程中的效果评价

目的 评价在为接受手术治疗的急性阑尾炎患者实施护理服务的过程中舒适护理的临床应用效果。方法 本次试验研究随机选择2019年1月至2020年1月期间在我院接受急性阑尾炎治疗的患者94例作为试验对象,以入院尾号奇偶数为依据,将患者分为接受常规护理服务的参与组和接受舒适护理的试验组,每组各有患者47例。对比分析两组患者的治疗效果。结果 统计分析两组患者手术时间、术中出血量、疼痛持续时间、住院时间以及并发症发生率和护理满意度后可知,试验组患者与参与组患者存在显著统计学差异(P <0.05)。结论 在为接受急性阑尾炎手术治疗的患者提供护理服务的过程中,舒适护理的运用可以缩短手术时间、疼痛持续时间和住院时间,减少了术中出血量,避免了各种并发症出现对患者造成的影响与伤害,具有较为理想的临床推广价值。

加速康复外科理念在腹腔镜阑尾切除手术围手术期护理中的应用

目的探讨加速康复外科理念在腹腔镜阑尾切除手术围手术期护理中的应用效果。方法选取南京中医药大学附属昆山市中医医院2020年1月至2021年12月诊治的280例急性阑尾炎患者,随机数字表法分为观察组(n=140)和对照组(n=140)。对照组为常规外科护理,观察组给予加速康复外科护理,比较两组患者的术后相关指标及病情恢复情况。结果观察组患者的术后首次肛门排气时间、术后首次下床时间、术后首次排便时间、术后刀口疼痛评分及住院时间方面均明显优于对照组,差异具有显著性(P<0.05)。观察组术后并发症总发生率为4.28%,低于对照组的10.71%,差异有显著性(P<0.05)。结论腹腔镜阑尾切除术围手术期实施加速康复外科护理,可促进患者术后胃肠功能恢复,缩短住院时间,降低术后并发症发生率。