腹腔镜阑尾切除术的常见难点与手术技巧.doc

腹腔镜阑尾切除术的常见难点与手术技巧 发表时间：2012-3-12 10:38:53 来源：创新医学网医学编辑部推荐 ? 　　作者：黄华,李红春,秦杰,陶红光,钱福永　　作者单位：深圳市第三人民医院，广东 深圳，518020 　　【摘要】 目的：探讨腹腔镜阑尾切除术(laparoscopic appendectomy,LA)的常见难点和手术技巧。方法：回顾分析我院近3年为220例阑尾炎患者行LA的临床资料。结果：216例在腹腔镜下顺利完成手术，4例中转开腹，阑尾取出困难62例，特殊位置阑尾18例，阑尾根部坏疽穿孔13例，阑尾周围重度粘连19例，阑尾显露困难12例，系膜出血7例，手术时间35～130min，住院时间3～9d，1例戳孔感染经对症处理后痊愈，无术后出血、肠粘连等并发症发生。结论：耐心、细致、熟练的腹腔镜外科技术是保证各种阑尾炎一期切除、减少并发症的关键。 　　【关键词】 阑尾切除术,阑尾炎,腹腔镜术 　　【Abstract】 Objective:To explore the common difficulties and surgical techniques of laparoscopic appendectomy(LA).Methods:The clinical data of 220 cases with appendicitis receiving LA in the last 3 years were analyzed retrospectively.Results:Two hundred and sixteen procedures of these cases were successfully done by laparoscopy,the other four cases conversed to conventional operation.It was difficult to dislodge appendix in 62 cases and to reveal appendix in 12 cases.There were 18 cases of ectopic appendix, 13 cases of appendix with gangrenous perforation at root,19 cases of severe adhesions around the appendix and 7 cases of the mesentery bleeding.The operative time were from 35min to 130min,the time of stay in hospital were 39 days.One case was complicated by infection of poke holes,who recovered after treatment.No other complication was found,such as postoperative hemorrhage,ankylenteron and so on.Conclusions:Patience,meticulosity and skillful technique of laparoscopy are the most important factors to guarantee the success of laparoscopic appendectomy and reduce the rate of complication. 　　【Key words】 Appendectomy;Appendicitis;Laparoscopy 　　由于腹腔镜阑尾切除术(laparoscopic appendectomy,LA)具有住院时间短、腹腔探查清楚全面、切口小、肠粘连几率小等优点，已越来越多的在临床推广[1]。2005年10月至2008年8月我院共施行LA 220例，效果满意。现将手术中的常见难点及手术技巧分析报道如下。 　　1 资料与方法 　　1.1 临床资料 220例中男128例，女92例; 13～82岁，平均32.6岁。其中单纯性(急性或慢性)阑尾炎102例,化脓性阑尾炎69例(5例形成阑尾周围脓肿),坏疽性阑尾炎59例(根部坏疽穿孔13例),特殊位置阑尾18例，发病至入院时间9～76h。所有病例均经病理学检查证实。 　　1.2 手术方法 均采用全身麻醉，于脐上缘做一10mm弧形切口，建立气腹，气腹压力12～15mm Hg。置入10mm Trocar，插入腹腔镜，探查腹腔明确诊断，排除胃肠道穿孔、出血、黄体破裂等急腹症及其他病变。按阑尾位置确定其他两个操作孔，