无永久异物存留的腹腔镜胆囊联合阑尾切除术  

Laparoscopic cholecystectomy combined with appendectomy without using titanium—clips

作　　者：陈玉秀[1,2] 杨昌平[1] 曹金林[1] 孙雪锋[3] 郭海鹰[3] 

机构地区：[1]解放军第117医院普外科,杭州310004 [2]杭州市五云山疗养院 [3]解放军第322医院普外科

出　　处：《浙江医学》2014年第18期1547-1549,共3页Zhejiang Medical Journal

摘　　要：目的：探讨简化的腹腔镜胆囊切除联合腹腔镜阑尾切除手术的可行性和安全性，以及达到术后远期腹腔不留异物的目的。方法对87例患者施行腹腔镜胆囊联合阑尾切除术。手术时采用全麻，不留置胃管、导尿管。采用4（3＋1）孔法，仅以单极电凝胆囊和阑尾动脉，胆囊管及阑尾残端各置1枚可吸收Tyco夹夹闭，或阑尾残端用可吸收普迪恩线“圈套器”套扎。结果81例患者手术顺利完成，6例因严重粘连、癌变、穿孔等并发症而中转开腹手术。无感染、出血和胆道损伤等并发症。手术时间40-80min（中转开腹除外），平均住院4d。结论只要手术操作者腹腔镜手术技能熟练并严格掌握联合手术原则和适应证，利用电凝和可吸收夹或圈套器处理血管、胆囊管及阑尾残端，腹腔镜下联合切除胆囊和阑尾是可行且安全的，并因弃用钛夹而达到术后腹腔不留永久性异物的效果。Objective To evaluate the efficacy and safety of laparoscopic cholecystectomy combined with appendectomy without using titanium- clips. Methods Eighty seven patients underwent laparoscopic cholecystectomy combined with appen-dectomy under general anesthesia. The cystic and appendix arteries were sealed by monopolar coagulation;cystic duct was oc-cluded with an absorbable clip and appendix stump was occluded with an absorbable clip or absorbable polydioxanone suture. Results Operation were successful y completed in al cases except 6, in whom the procedures were converted to open surgery due to severe adhesion, cancer or perforation. No infection, bleeding or bile duct injury occurred. The median operative time was 65min （40-80min）, except in cases requiring open surgery. The mean hospital stay was 4 days. Conclusion Laparoscopic cholecystectomy combined appendectomy with electrocoagulation of arteries and occlusion of cystic duct and appendix stump by absorbable clip or absorbable suture is safe and effective method;there are no intraabdominal foreign bodies left.

关 键 词：无永久异物 电凝血管 腹腔镜手术 胆囊切除术 阑尾切除术 

分 类 号：R656[医药卫生—外科学]