腹腔镜阑尾切除术阑尾残端荷包缝合包埋与Hem-o-lok的比较

目的探讨荷包缝合包埋阑尾残端在腹腔镜阑尾切除术中的应用价值。方法2010年6月-2013年6月因急慢性阑尾炎行腹腔镜阑尾切除术101例,采用2种不同方法处理阑尾残端：50例阑尾根部行丝线结扎后,荷包缝合包埋残端（包埋组）;5l例用Hem-o-lok夹闭阑尾根部后,不再进一步处理阑尾残端（Hem-o-lok组）,比较2组手术时间和术后患者恢复情况。结果2组术后并发症、术后住院时间无显著性差异（P〉0．05）。包埋组手术时间（55．8±5．8）min,明显长于Hem-o-lok组（44．8±5．7）min（t=9．613,P=0．000）;包埋组手术费用（5086±58）元,显著少于Hem-o-lok组（5430±50）元（t=-31．945,P=0．000）。结论2种处理阑尾残端的方法都是安全、有效的,但荷包缝合包埋阑尾残端更符合传统阑尾切除术的手术操作要求,对术者腹腔镜操作水平要求较高,但节省手术费用。Hem-o-lok夹闭阑尾根部节省手术时间,操作简单,更适合于初学者。     

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

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。     

阑尾切除术不同残端处理方法的临床评价

阑尾切除术残端处理有三种方法,即根部结扎后荷包包埋、根部不结扎直接荷包包埋以及根部单纯结扎法。近来,随着腹腔镜阑尾切除术的开展,根部单纯结扎法逐渐增多。不同的残端处理方法对阑尾切除术的临床疗效有无影响令人关注。本文对此进行研究,报道如下。     

腹腔镜阑尾切除术阑尾残端两种处理方法的对比研究

目的:对比研究腹腔镜阑尾切除术(laparoscopic appendectomy,LA)中阑尾残端的两种处理方法。方法:2004年7月至2013年6月为216例患者行LA,将其随机分为夹闭组(n=86)与荷包组(n=130),夹闭组在处理阑尾系膜后采用钛夹或高分子结扎钉直接夹闭阑尾残端;荷包组处理阑尾系膜后缝扎阑尾残端,并荷包缝合包埋。对比分析两组手术时间、术中出血量、术后肠功能恢复时间、术后住院时间及并发症发生率。结果:两组患者手术过程顺利,无中转开腹及严重并发症发生。夹闭组手术时间短于荷包组[(27±9)min vs.(38±12)min,P=0.04];术中出血量[(12±6)ml vs.(14±7)ml,P=0.17]、术后肠功能恢复时间[(26±8)h vs.(28±9)h,P=0.25]及术后住院时间[(2.7±1.8)d vs.(2.9±1.6)d,P=0.14]两组差异无统计学意义;夹闭组中8例出现下腹不适,3例术后出现腹痛,5例出现术后发热,1例行二次手术;荷包组中3例出现下腹不适,1例术后腹痛,2例出现术后发热,无二次手术。夹闭组术后并发症发生率(19.8%vs.4.6%,P<0.01)及粘连性肠梗阻发生率(8.1%vs.3.1%,P<0.01)显著高于荷包组。结论:应用荷包包埋法处理阑尾残端手术时间略长,但术后并发症发生率低,是LA术中阑尾残端安全的处理方法。     

腹腔镜阑尾切除术残端荷包包埋61例

目的总结腹腔镜阑尾切除术残端荷包包埋的手术经验。方法回顾分析2009年7月至2010年6月施行的61例腹腔镜阑尾切除术,术中阑尾残端均行荷包包埋,阐述手术的经验体会。结果 61例腹腔镜阑尾切除术残端荷包包埋均成功完成,无一例发生副损伤及并发症。结论腹腔镜下阑尾残端荷包包埋是安全可行的,不增加患者的手术费用,值得推广。     

腹腔镜阑尾切除术残端包埋技巧及临床应用

目的探讨腹腔镜阑尾切除术（LA）残端包埋技巧及临床应用。方法自2008年1月至2011年2月,行LA86例,采取四针正向浆肌层缝合包埋阑尾残端。结果 86例LA均顺利完成阑尾残端包埋,手术时间22～70min,平均36min,术后住院时间2～5d,平均2.8d,无并发症发生。随访71例,随访时间3～12个月,无腹痛症状及其他并发症发生。结论腹腔镜下四针正向缝合包埋阑尾残端,符合缝合习惯,操作简单,安全可行,容易在临床开展应用。     

阑尾切除术预防阑尾残端瘘的处理方法

正阑尾残端瘘是阑尾切除术后严重的并发症之一,发生率0.7%~3.7%[1],严重影响手术效果及预后。2012-10—2016-02,我院共实施236例阑尾炎切除手术,术中将阑尾残端荷包包埋后,将阑尾系膜或周围组织覆盖其上,术后无1例发生阑尾残端瘘,现报道如下。1资料与方法1.1一般资料本组236患者中男168例,女68例;年龄7~82岁,平均54.82岁。单纯性阑尾炎139例,化脓性阑尾炎71例,     

经脐单孔腹腔镜阑尾切除术的临床体会

目的:探讨经脐单孔腹腔镜阑尾切除术的应用前景.方法:回顾分析为16例患者行经脐单孔腹腔镜阑尾切除术的手术方法及疗效.结果:1例中转传统腹腔镜手术,15例手术获得成功,手术时间27～63 min,平均46 min,术后平均6h下床活动,平均8h排气,平均住院2.7 d,均无并发症发生.结论:经脐单孔腹腔镜阑尾切除术美容效...     

Video laparoscopic appendectomy. Our experience

OBJECTIVE: Personal experience with the use of VL in the treatment of acute appendicitis (AA) is reported. The main advantage of this method is its high diagnostic reliability. SETTING: Chirurgia Generale I. Dipartimento di Discipline Chirurgiche e Anatomiche. Policlinico Università Palermo. SUBJECTS: The VL method has been used in 36 patients with diagnosis of suspect acute appendicitis. INTERVENTIONS: In the cases in which the diagnosis has been confirmed, a VL appendectomy with endoabdominal technique according to Semm has been performed in 23 cases, and an assisted VL appendectomy, trough a minimal and guided laparotomy, in 8 cases. In order to avoid vascular and visceral injuries, an "open" laparoscopy technique is always used. RESULTS: The diagnosis has been confirmed in 31 cases, 21 women and 10 men. The diagnosis has not been confirmed in 5 cases, a man of 74 years with sigmoidal diverticulitis and 4 women with terminal ileitis in a case, torsion of right ovarian cyst in another and, finally, pelvic inflammatory disease in 2. CONCLUSIONS: From this brief experience it is evident the diagnostic advantage of VL particularly in the female and in elderly patients. Other advantages of this method are the excellent aesthetic result, light postoperative pain, the rapid functional resumption, the small impact of adherences, wound infection, and incisional hernia, and the lower cost, when staplers are not used. The disadvantages are the extension of the operative time, using the "open" laparoscopy technique, and the difficulty to find Meckel diverticulum.     

简化的腹腔镜胆囊联合阑尾切除术的应用体会

目的:探讨简化的腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜阑尾切除术(laparoscopic ap-pendectomy)的可行性及安全性。方法:为42例患者行LC联合LA。术中电凝胆囊动脉、阑尾动脉,胆囊管仅施夹一枚可吸收生物夹,阑尾残端用普迪恩线圈套器套扎。结果:42例手术均顺利完成,均无感染、出血及胆道损伤等并发症发生。手术时间40～70 min,中位55 min;平均住院4 d。结论:术者具有娴熟的腹腔镜手术操作技能、严格掌握联合手术原则与适应证,LC联合LA是快捷可行的,手术安全有效。     

腹腔镜下阑尾残端的处理体会

目的:研究腹腔镜阑尾切除术(laparoscopic appendectomy,LA)术中阑尾残端的处理方法。方法:收集2010年10月至2016年4月448例行LA患者的临床资料。术中采取3种方法处理阑尾残端:应用套扎线行阑尾残端双重套扎(套扎法,n=312)、荷包缝合阑尾残端(荷包缝合法,n=112)、可吸收线缝合阑尾残端(可吸收线缝合法,n=24)。结果:套扎法312例患者基本恢复良好,术后11例出现右下腹轻微痛,2～3 d后消失。荷包缝合法112例患者术后恢复良好。可吸收线缝合法24例患者术后基本恢复良好,3例化脓性阑尾炎患者术后出现发热、腹痛,2～4 d后排气,症状消失。结论:LA术中处理阑尾残端应遵循开腹手术的处理原则,套扎阑尾残端方便可行,节省时间;荷包缝合包埋法是首选方法;可吸收线缝合阑尾残端适于阑尾根部坏疽的患者。     

Early experience with laparoscopic appendectomy in women

Summary Experience and the surgical technique of laparoscopic appendectomy in 70 female patients over a period of more than three years is described. Three women were pregnant. Complications occurred in one case.     

Single-incision laparoscopic appendectomy: an early experience

Acute appendicitis is one of the most common causes of abdominal pain that a general surgeon will encounter. We describe our modification to the laparoscopic appendectomy: a single-incision laparoscopic (SILS) appendectomy completed entirely intracorporeally. From September 2008 to September 2009, a retrospective review of the electronic medical record was performed in all patients who underwent a SILS appendectomy to specifically analyze the demographic characteristics, time in the operating room to perform SILS appendectomy, length of postoperative hospital stay, and postoperative complications. Twenty-five patients underwent SILS appendectomy in the study period. There were 18 males and seven females with a mean age of 41 ± 15 years and mean body mass index of 26.5 ± 5 kg/m2. Single-incision laparoscopic appendectomy was performed successfully in all of our cases (100%). Mean operative time was 56 ± 16 minutes. Blood loss in all cases was minimal and there were no intraoperative complications. We successfully completed 25 appendectomies using the SILS method. Operative times were similar compared with the traditional laparoscopic technique. We believe that the SILS appendectomy is a safe and effective method that leaves a virtually invisible scar.     

腹腔镜阑尾切除术术中阑尾系膜的不同处理方式

目的探讨腹腔镜阑尾切除术术中多种阑尾系膜处理方式的优缺点。方法 260例腹腔镜阑尾切除术使用6种方式处理阑尾系膜,其中钛夹、结扎夹夹闭法20例,PK刀、超声刀离断法18例,单极电凝法110例,双极电凝法13例,丝线结扎法96例,直线切割闭合器（EndoGIA）离断法3例。比较6种处理方式的疗效、手术时间及预后。结果 260例腹腔镜阑尾切除术术中分别使用不同的阑尾系膜处理方式,均顺利完成手术。结论在确保止血效果的前提下,应根据术者的经验和能力、设备条件及患者的经济承受能力选择适宜的方法。     

腹腔镜阑尾切除术50例报告

目的 探讨腹腔镜下阑尾系膜缝扎及残端包埋缝合行阑尾切除术的可行性,手术技巧.方法 回顾分析50例腹腔镜阑尾切除术的临床资料.结果 48例阑尾炎患者手术成功;2例患者转开放手术,其中1例是阑尾周围脓肿,另1例是回盲部肿块.手术时间30～105 min,住院时间3～6 d,平均4 d.术后无出血,肠漏,肠梗阻等并发症.结论 腹腔镜下阑尾系膜的缝扎及残端的包埋缝合行阑尾切除术可行且安全,患者住院时间短,费用低,无钛夹遗留,同时也使外科医师的腹腔镜技术水平得到了很大的提高.     

Single-incision laparoscopic appendectomy for acute appendicitis: a preliminary experience

Background  

Natural orifice translumenal endoscopic surgery (NOTES) is a major conceptual change in the field of modern surgery. However, corresponding technological refinements are not yet available to fill the gap separating the current laparoscopy from the NOTES of the future. Meanwhile, “hybrid” NOTES techniques, including single-port procedures, have been increasingly reported. This report describes a technique of single-incision laparoscopic appendectomy (SILA) for selected patients with acute appendicitis.