腹腔镜手术治疗复杂性阑尾炎  

Laparoscopic Appendectomy for Complicated Appendicitis:A Report of 87 Cases

作　　者：赵威威[1] 陈宇罡[1] 张克玲[1] 李久澄[1] 米泰宇[1] 

机构地区：[1]甘肃省兰州市第二人民医院普外三科,兰州730046

出　　处：《中国微创外科杂志》2013年第7期636-637,644,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的总结腹腔镜手术治疗复杂性阑尾炎的经验。方法 2008年2月～2012年2月对87例复杂性阑尾炎(坏疽、穿孔性阑尾炎或阑尾周围脓肿形成)行腹腔镜手术,术式包括腹腔镜阑尾切除联合腹腔冲洗引流,腹腔镜下阑尾脓肿清创引流术。结果无死亡病例,3例中转开腹,4例阑尾周围脓肿形成需要行二期阑尾切除术。手术时间(54±21)min,术后肛门排气时间(38±13)h,术后住院时间(5.0±1.4)d。术后6例出现并发症,其中戳孔感染3例,切口换药后愈合;腹腔残余脓肿2例,抗炎治疗后脓肿逐渐吸收;粪漏1例,经过肠外营养支持、充分引流及使用抗生素后愈合。80例随访8～44个月,平均14个月,2例出现粘连性肠梗阻,余无其他并发症出现。结论腹腔镜手术治疗复杂性阑尾炎是安全有效的。Objective To summarize our experiences of laparoscopic appendectomy for complicated appendicitis.Methods Between February 2008 and February 2012,we performed laparoscopic appendectomy on 87 cases of complicated appendicitis,which were identified as gangrenous,perforated appendicitis and periappendiceal abscess.The procedure included laparoscopic appendectomy combined with peritoneal irrigation,laparoscopic debridement and drainage of periappendiceal abscess.Results All the operations were successful without any perioperative deaths.3 patients were converted to laparotomy and 4 patients with periappendiceal abscess needed a two-stage appendectomy.The operation time was（54±21） min,the time of anal exsufflation was（38±13）h,and the postoperative hospital stay was（5.0±1.4） d.Postoperative complications occurred in 6 cases,including 3 cases of port-site infection and 2 cases of residual intraabdominal abscesses.All the 5 cases recovered after treatment.One patient experienced a fecal fistula postoperatively and healed with conservative treatment.Eighty patients were followed up for 8 to 44 months,with an average of 14 months.Adhesive ileus occurred in 2 patients and no other complications were found.Conclusion Laparoscopic surgery is safe and effective in treating complicated appendicitis.

关 键 词：复杂性阑尾炎 腹腔镜阑尾切除术 

分 类 号：R656.8[医药卫生—外科学]