目的 总结腹腔镜阑尾切除术(laparoscopic appendectomy,LA)治疗阑尾炎的经验。方法 回顾性分析1999年8月至2006年8月我院行LA治疗的132例阑尾炎患者的临床资料,其中慢性阑尾炎急性发作19例,急性单纯性阑尾炎15例,急性化脓性阑尾炎93例,阑尾穿孔腹膜炎5例。结果 2例中转开腹。130例成功完成LA,手术时间22~55 min,平均30.5 min; 术中出血量2~10 ml; 住院2~12 d,平均3.4 d。术后出现早期炎性肠梗阻1例,经非手术治疗治愈。结论 LA操作简便可行,操作得当可在基层医院推广。
目的:分析X线对小儿穿孔性阑尾炎的诊断价值。方法:对经临床手术证实为穿孔性阑尾炎50例的腹部X线平片资料(含12例B超、7例CT资料)作回顾性分析。结果:X线表现为右侧胁腹脂线短缩及腹脂线髂段模糊41例,横结肠充气征43例,小肠积气(小肠环内径≤3 cm)12例、胀气(小肠环内径gt;3 cm)38例,小肠积液50例,小肠壁增厚32例,回盲部密度增高并小气泡影12例,右侧腹腔少量游离气体1例。结论:X线检查对穿孔性阑尾炎有一定诊断价值,结合超声检查和/或CT检查可提高诊断准确率。
目的探讨碘伏原液浸泡对于预防阑尾Ⅲ类手术切口手术部位感染(SSI)的疗效。 方法回顾性分析笔者所在医院2012年5月至2013年5月期间施行阑尾切除术者中切口类型为Ⅲ类的92例患者的临床资料,比较以碘伏原液浸泡切口(浸泡组)和冲洗切口(常规组)处理后患者的切口愈合情况。 结果术后常规组57例患者中,有43例切口愈合等级为甲级,5例为乙级,9例为丙级,SSI发生率为24.56%(14/57)。浸泡组35例患者的切口愈合均良好,均为甲级愈合,SSI发生率为0,低于常规组(P<0.05)。 结论采用碘伏原液浸泡切口5 min能有效预防阑尾炎Ⅲ类切口SSI的发生,值得临床推广应用。
ObjectiveTo further explore and discuss the value of laparoscopic appendectomy. MethodsThe clinical data of 200 patients underwent appendectomy in this hospital from April 2009 to December 2010 were collected. The operation time, postoperative hospital stay, cost of hospitalization, postoperative anal exhaust time, postoperative pain score, and surgical complications were compared between laparoscopic appendectomy and open appendectomy. ResultsThere were 8 cases conversion to the open approach in this series. The cost of laparoscopic appendectomy was higher than that of open appendectomy (Plt;0.05); the cases of chronic appendicitis, acute simple appendicitis, acute suppurative appendicitis within 36 h of onset treated by laparoscopic appendectomy had shorter operation time, shorter postoperative hospital stay, earlier postoperative anal exhaust time, and slighter postoperative pain than those treated by open appendectomy (Plt;0.05); the differences in postoperative hospital stay, postoperative anal exhaust time, postoperative pain of acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis treated by two types of surgery had no statistical significances (Pgt;0.05); the operation time of acute gangrenous appendicitis operated by laparoscopic surgery was longer than that by open appendectomy (Plt;0.05); incision infection rate of laparoscopic appendectomy was lower than that of open appendectomy (Plt;0.05). ConclusionsFor chronic appendicitis, acute simple appendicitis, and acute suppurative appendicitis within 36 h of onset, the outcome and advantages of laparoscopic appendectomy are outstanding, the value of application is clear; and for acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis, laparoscopic appendectomy is difficult and with high rate of conversion, no obvious advantages in recovery after surgery but an increase of medical costs, and the application value is not great.
目的 探讨原发性阑尾粘液腺癌的诊断和治疗。 方法 对国内1980年以来报道的原发性阑尾粘液腺癌15例的文献资料及我院收治的2例患者的临床资料进行回顾性分析。 结果 该17例患者的主要临床表现为右下腹疼痛,右下腹近腹股沟处包块及腹痛、腹泻伴便血; 术前诊断为盲肠癌3例,急、慢性阑尾炎各4例,菌痢2例,阑尾脓肿、疝囊嵌顿、腹壁脓肿及肠梗阻各1例。 结论 原发性阑尾粘液腺癌是一种罕见疾病,诊断强调术中仔细鉴别,B超、胃肠X线钡餐和CT检查有助于诊断,病理组织学检查可确诊,治疗以手术为主,化疗为辅。
目的 探讨隐蔽三孔法腹腔镜阑尾切除术的应用。方法 患者取头低左侧卧位。在脐缘切口插入10 mm的套管,放入腹腔镜。在腹腔镜监视下分别于耻骨结节左、右侧阴毛生长区作10 mm、5 mm切口,两切口相距8~10 cm。术者通过耻骨上途径完成阑尾切除操作。结果 192例痊愈出院,无一例手术中转,平均手术时间(25±4.32) min,平均住院时间(5±0.79) d。切口甲级愈合,基本不留疤痕。无手术并发症发生。结论 隐蔽三孔法腹腔镜阑尾切除术具有美容效果好、创伤小、并发症少等优点。