根部坏疽穿孔复杂阑尾炎的腹腔镜手术治疗体会  

The experience of laparoscopic surgery for complex appendicitis with root gangrene perforation

作　　者：戚峰 姜国华 刘晓东 国涛 许可丽 QI Feng;JIANG Guohua;LIU Xiaodong(Department of General Surgery,the Greater Khingan Range People's Hospital,Greater Khingan Range 165000,China)

机构地区：[1]大兴安岭地区人民医院普通外科,黑龙江大兴安岭165000

出　　处：《腹腔镜外科杂志》2024年第4期294-297,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨倒刺线在根部坏疽穿孔性阑尾炎腹腔镜手术中的应用效果。方法:回顾分析2020年7月至2023年6月收治的47例根部坏疽穿孔性阑尾炎患者的临床资料,其中男28例,女19例,平均(50.9±14.1)岁;均行腹腔镜阑尾切除术,术中采用倒刺线全层连续缝合阑尾残端。观察术中、术后及并发症情况。结果:47例患者均顺利完成手术,无中转开腹。手术时间平均(82.8±29.1)min;阑尾残端缝合时间平均(7.6±3.1)min;术中出血量平均(22.1±11.7)mL;胃肠功能恢复时间(35.1±13.8)h;拔除腹腔引流管时间(5.9±2.2)d;术后住院(11.1±4.0)d。术后临床病理分型:急性坏疽穿孔性阑尾炎29例,阑尾周围脓肿18例。术后发生3例戳孔感染、1例右下腹炎性包块、2例腹腔脓肿,无阑尾残端瘘、肠瘘发生。47例患者均获随访,随访3~12个月,无粘连性肠梗阻等并发症发生。结论:腹腔镜手术中应用倒刺线全层连续缝合阑尾残端治疗根部坏疽穿孔性阑尾炎是安全、有效的,可降低腹腔镜下缝合难度,值得临床推广应用。Objective:To explore the application effect of barbed suture in laparoscopic surgery for gangrenous appendicitis with root perforation.Methods:The clinical data of 47 patients with root gangrenous perforated appendicitis who underwent laparoscopic appendectomy from Jul.2020 to Jun.2023 were retrospectively analyzed.There were 28 males and 19 females with the average age of(50.9±14.1)years.47 patients underwent full-layer continuous suture of appendix stump with barbed wire.The intraoperative and postoperative situations and occurrence of complications were observed.Results:All of 47 patients underwent operations successfully without conversion to open surgery.The mean operation time was(82.8±29.1)min,and the average suture time of the appendix stump was(7.6±3.1)min.The intraoperative blood loss was(22.1±11.7)mL.The recovery time of gastrointestinal function,removal time of abdominal drainage tube and postoperative hospitalization time were(35.1±13.8)h,(5.9±2.2)d and(11.1±4.0)d respectively.Postoperative clinical pathological classification included 29 cases of acute gangrenous perforated appendicitis and 18 cases of peria-ppendiceal abscess.After surgery,3 patients experienced incision infection,1 patient suffered from inflammatory mass in the lower right abdomen and 2 patients suffered from abdominal abscess,no appendiceal stump fistula or intestinal fistula occurred in all patients.All 47 p atients were followed up for 3-12 months,and no complications such as adhesive intestinal obstruction occurred during the follow-up period.Conclusions:It is safe and effective to use full-thickness continuous suture of the appendix stump with barbed suture in laparoscopic surgery for gangrenous appendicitis with root perforation,which could reduce the difficulty of laparoscopic suturing.It is worth clinical promotion and application.

关 键 词：坏疽穿孔性阑尾炎 阑尾切除术 腹腔镜检查 倒刺线 

分 类 号：R656.8[医药卫生—外科学]