“优化三孔法”和“帆式”构型技术在腹腔镜阑尾切除术中的应用  

Application of“Optimized Three-hole Method”and“Sail”Configuration Technique in Laparoscopic Appendectomy

作　　者：许英晨[1] 邢冰琛 沈凯[1] 杨伯钊[1] 计嘉军[1] 张立军[1] 张东欣 伍冀湘 Xu Yingchen;Xing Bingchen;Shen Kai(Department of General Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100176,China)

机构地区：[1]首都医科大学附属北京同仁医院普外科,北京100176

出　　处：《中国微创外科杂志》2022年第10期799-802,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：北航-首医大数据精准医疗高精尖创新中心同仁分中心开放基金项目(BHTR-KFJJ-202011)。

摘　　要：目的探讨“优化三孔法”和“帆式”构型技术在腹腔镜阑尾切除术(laparoscopic appendectomy,LA)中的应用。方法2017年1月~2022年1月对我院收治的130例阑尾炎采用脐部切口、麦氏点及反麦氏点切口,以及调整反麦氏点为观察孔和脐部切口为主操作孔为特点的“优化三孔法”和将阑尾系膜提起形成“帆式”构型技术施行LA。结果130例均顺利完成手术,术后均未发生并发症。手术时间(56.9±23.6)min。术中出血量1~30 ml,中位出血量5 ml。术后病理:急性单纯性阑尾炎19例,急性化脓性阑尾炎72例,急性坏疽性阑尾炎25例,慢性阑尾炎14例。术后1、3、6个月规律随访,除2例合并慢性肠道疾病和4例合并右侧附件炎或盆腔炎的女性患者术后仍有右下腹隐痛不适以外,其余124例(95.4%)未再出现右下腹痛症状。结论优化的LA安全可行,值得临床上推广。Objective To explore the application of“optimized three-hole method”and“sail”configuration technique in laparoscopic appendectomy.Methods Between January 2017 and January 2022,a total of 130 patients with appendicitis were enrolled.The surgery was performed by using periumbilical incision,Mcburney’s point and opposite Mcburney’s point incisions.The“optimized three-hole method”was characterized by adjusting the opposite Mcburney’s point incision as the observation hole and the periumbilical incision as the main operation hole,and the technique of lifting the appendix mesentery to form a“sail”configuration.Results The operations were successfully completed in all the patients without postoperative complications.The operation time was(56.9±23.6)min and the intraoperative blood loss was 1-30 ml(median,5 ml).Postoperative pathology showed 19 cases of acute simple appendicitis,72 cases of acute suppurative appendicitis,25 cases of acute gangrenous appendicitis,and 14 cases of chronic appendicitis.Regular follow-ups for 1,3 and 6 months after operation showed that except for 2 patients with chronic intestinal diseases and 4 female patients with right adnexitis or pelvic inflammation who still had pain and discomfort in the right lower abdomen,the remaining 124 patients(95.4%)had no symptoms of right lower abdomen pain.Conclusion The optimized laparoscopic appendectomy is safe and feasible and suitable for clinical application.

关 键 词：阑尾炎 腹腔镜阑尾切除术 

分 类 号：R656.8[医药卫生—外科学]