《外科学课件-协和医院》24阑尾疾病acute appendicits-蔡开琳.pptVIP

CAIKAILIN 联合内镜技术 —更精准，更微创，更合理！ CAIKAILIN * * * * * * Contraindications to laparoscopic appendectomy include 1) significant intra-abdominal adhesions and 2) pregnancy beyond the first trimester antibiotics The antibiotics used should cover the aerobic and anaerobic flora, enterococci and gram(-) intestinal flora . Given preoperatively. CAIKAILIN Surgery Definitive intervention Performed once the diagnosis is made. Although in certain cases, the surgery should be delayed Delayed treatment increases mortality Appendectomy the standard operation CAIKAILIN CAIKAILIN CAIKAILIN CAIKAILIN CAIKAILIN Procedure Transversus muscle split ? expose underlying peritoneum mobilize the cecum and exteriorize the appendix CAIKAILIN Divide the mesoappendix and ligate the vessels CAIKAILIN CAIKAILIN Open or keyhole? Laparascopic + Faster recovery time + Increased cosmetic satisfaction + decreased post-op wound infection operating time… More costly Open + cheaper Indicated for perforated appendicitis b/c assoc w/ decreased post-op abscess formation precise diagnosis in uncertain cases (esp. young women) CAIKAILIN Prophylactic appendectomy? Incidental appendectomy? CAIKAILIN Certain Select groups for prophylactic appendectomy: Pts. With fixation of appendix to ovary or tube Apppendiceal fecalith or calculus in whom abdominal radiation is anticipated undergoing major surgery in whom major adhesions are anticipated postoperatively in whom future contraindications to abdominal surgery are anticipated Opinion not consensus CAIKAILIN Contraindicated to prophylaxic resection Crohn’s Disease Inaccessible appendix Hx of prior abdominal radiation tx Vascular grafts Material in Abdomen Unstable medical condtion CAIKAILIN Treatment options to special types  inflammatory pseudotumor – conservative treatment antibiotics, fluid i.v., nothing by mouth abscess drainage ultrasound guided surgical CAIKAILIN CAIKAILIN CAIKAILIN Complications Related to