277例老年患者坏疽性阑尾炎腹腔镜下手术经验总结  

Experience of laparoscopic appendectomy in elderly patients with gangrenous appendicitis

作　　者：仝小刚[1] 王悦华[1] 江华[1] TONG Xiaogang;WANG Yuehua;JIANG Hua(Department of General Surgery,Xuan Wu Hospital of Capital Medical University,Beijing,100053,China)

机构地区：[1]首都医科大学宣武医院普外科,北京100053

出　　处：《临床急诊杂志》2021年第12期843-846,共4页Journal of Clinical Emergency

基　　金：教育部人文社会科学研究项目(No:14YJAZH083)。

摘　　要：目的:总结近10年来首都医科大学宣武医院针对老年坏疽性阑尾炎患者腹腔镜手术的经验。方法:对2010年1月—2020年6月期间于首都医科大学宣武医院因坏疽穿孔性阑尾炎行腹腔镜手术治疗的65岁以上老年患者的临床资料进行回顾性分析,所有患者均经手术确诊为坏疽性阑尾炎。手术方式主要采用以右上腹切口为主操作孔的三孔法腹腔镜阑尾切除术,少数行开腹手术治疗及单孔腹腔镜手术治疗。结果:本研究共纳入277例次患者,平均年龄为(71.35±8.35)岁,所有手术均顺利完成;三孔法手术时间平均56min,平均出血量25.3mL,术后腹腔脓肿发生率3.12%;单孔法手术时间平均75min,平均出血量28.3mL,术后腹腔脓肿发生率13.04%。三孔法与单孔法比较,手术时间缩短,术后腹腔脓肿发生率降低。结论:针对老年急性坏疽性阑尾炎患者以采用右上腹为主操作孔的三孔法腹腔镜阑尾切除方式可取得较好疗效及较低的围术期并发症。Objective:To summarize the experience of laparoscopic surgery for elderly patients with gangrenous appendicitis in Xuanwu Hospital of Capital Medical University in recent 10years.Methods:From January 2010to June 2020,elderly patients over 65years old with gangrenous perforated appendicitis who underwent laparoscopic surgery in Xuanwu Hospital of Capital Medical University were retrospectively analyzed.Three hole laparoscopic appendectomy with right upper abdominal incision as the main operation hole was used as the main operation method,and a few laparotomy and single hole laparoscopic appendectomy were used.Results:A total of 277 patients were included in this study,the average age was 71.35±8.35years old,all operations were successfully completed;the average operation time of three hole method was 56minutes,the average blood loss was 25.3mL,the incidence of postoperative abdominal abscess was 3.12%;the average operation time of single hole method was 75minutes,the average blood loss was 28.3 mL,the incidence of postoperative abdominal abscess was 13.04%.Compared with single hole method,the three hole method can shorten the operation time and reduce the incidence of postoperative abdominal abscess.Conclusion:For elderly patients with acute gangrenous appendicitis,laparoscopic appendectomy with right upper abdomen as the main operating hole can achieve better curative effect and lower perioperative complications.

关 键 词：腹腔镜 坏疽性阑尾炎 阑尾切除术 老年患者 

分 类 号：R656.8[医药卫生—外科学]