免气腹腹腔镜阑尾切除术在老年患者中的临床应用  

Clinical application of laparoscopic appendectomy without pneumoperitoneum in elderly patients

作　　者：温泽霖 简斌[1] 吴帅[1] 谢建[1] 白鍊 WEN Ze-lin;JIAN Bin;WU Shuai;XIE Jian;BAI Lian(Department of Gastrointestinal Surgery,Yongchuan Hospital Affilliated to Chongqing Medical University,Chongqing 402160,China)

机构地区：[1]重庆医科大学附属永川医院胃肠外科,重庆402160

出　　处：《局解手术学杂志》2018年第11期792-796,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：重庆市永川区科委自然基金(Ycstc;2015nc5021)

摘　　要：目的探讨免气腹腹腔镜阑尾切除术在老年阑尾炎患者治疗中的安全可行性。方法回顾性分析2015年7月至2017年10月重庆医科大学附属永川医院胃肠外科收治的120例老年阑尾炎患者的临床资料。患者均施行阑尾切除术,按照手术方式的不同分为免气腹腹腔镜阑尾切除术(免气腹组) 55例、腹腔镜阑尾切除术35例(气腹组)、开腹阑尾切除术患者30例(开腹组)。观察并记录患者的CO2结合率、手术时间、出血量、皮下血肿形成、皮下气肿形成、酸中毒、腹腔脏器损伤情况及意外的血管损伤。记录患者术后肛门排气时间、腹痛持续时间、伤口愈合、发热、住院时间等术后恢复情况。结果 3组患者均顺利完成手术,免气组、气腹组手术时间均短于开腹组,差异具有极显著性统计学意义(P <0. 01),但免气腹组与气腹组差异无统计学意义(P> 0. 05);术中出血量3组间比较差异无统计学意义(F=0. 492,P>0. 05); 3组患者术前CO2结合率差异无统计学意义(F=0. 34,P> 0. 05),术后气腹组CO2结合率明显高于免气腹组与开腹组(F=100. 189,P <0. 05);肛门排气时间,术后免气腹组、气腹组均早于开腹手术组,3组比较差异有统计学意义(F=27. 683,P <0. 01);但免气腹组与气腹组之间差异无统计学意义(P> 0. 05);腹痛时间,术后免气腹组与气腹组均短于开腹组,差异具有极显著性统计学意义(P <0. 01),免气腹组与气腹组之间差异无统计学意义(P> 0. 05);平均住院时间,免气腹组、气腹组均短于开腹组,差异具有极显著性统计学意义(P <0. 01),免气腹组与气腹组间差异无统计学意义(t=-0. 412,P> 0. 05)。3组患者发生酸中毒、皮下血肿、皮下气肿、肺部感染等感染指标差异无统计学意义(P> 0. 05)。3组患者均获得随访,中位随访时间为16个月(8～24个月)。开腹组有1例盆腔脓肿形成,2例术后肠粘连肠梗阻再次入院。3组患者均无切口疝形成,无�Objective To explore the feasibility and security of gasless laparoscopic appendectomy in the treatment of patients with senile appendicitis. Methods Retrospectively analyzed the clinical data of 120 elderly patients with acute suppurative appendicitis who underwent appendectomy in Yongchuan hospital Chongqing medical university from July 2015 to October 2017. Among them,55 patients were treated with laparoscopic appendectomy without pneumoperitoneum（gasless laparoscopic surgery group）,35 patients received laparoscopic appendectomy（laparoscopic group）,and 30 patients underwent open appendectomy（open abdomen group）. The CO2 binding rate,duration of operation,amount of bleeding,subcutaneous hematoma,subcutaneous emphysema,acidosis,abdominal viscera injury and accidental vascular injury were observed and recorded. The postoperative anal exhaust time,duration of abdominal pain,wound healing time,fever and hospitalization stays were recorded. Results Three groups of patients were successfully completed surgery,the operation time of gasless laparoscopic surgery group and laparoscopic group were shorter than that of open abdomen group,the difference had outstanding statistical significance（P 〈 0. 01）,but there was no significant difference between gasless laparoscopic surgery group and laparoscopic group（P 〉 0. 05）. There was no significant difference in intraoperative blood loss of the three groups（F = 0. 492,P 〉 0. 05）. There was no significant difference in preoperative CO2 binding rate of the three groups（F = 0. 34,P 〉 0. 05）. The postoperative CO2 binding rate of the laparoscopic group was significantly higher than those of the other two groups（F = 100. 189,P 〈 0. 05）. The postoperative anal exhaust time of gasless laparoscopic surgery group and laparoscopic group were earlier than that of open abdomen group,the difference were statistically significant in three groups（F = 27. 683,P 〈 0. 01）,but there was no significant difference between gasless laparoscopic surgery

关 键 词：免气腹 腹腔镜 开腹 老年 微创 阑尾切除术 

分 类 号：R619.5[医药卫生—外科学]