腹腔镜下倒刺线缝合包埋阑尾残端用于根部坏疽性阑尾炎疗效分析  

Laparoscopic treatment of gangrenous appendicitis at the base using the barbed wire for closure of the residual appendiceal stump

作　　者：俞如胜 吴鸿耀 Yu Rusheng;Wu Hongyao(Department of General Surgery,Fujian Tingzhou Hospital,Longyan 366300,Fujian Province,China)

机构地区：[1]福建省汀州医院普外科,龙岩366300

出　　处：《中国基层医药》2024年第10期1512-1516,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的分析腹腔镜下处理根部坏疽性阑尾炎使用倒刺线缝合包埋阑尾残端的疗效。方法采用病例对照研究。选取福建省汀州医院普外科2018年1月至2022年12月收治的急性根部坏疽阑尾炎患者58例为研究对象,根据术中处理阑尾残端包埋使用的缝线种类不同,将其分为对照组(采用可吸收线间断全层缝合包埋法)28例和观察组(采用倒刺线连续性全层缝合法包埋阑尾残端)30例。比较两组术中、术后相关指标及术后并发症发生率。结果观察组残端包埋时间为(4.17±0.66)min,短于对照组的(6.11±0.68)min;中转开腹率为3.33%(1/30),低于对照组的21.42%(6/28),差异均有统计学意义(t=10.98,χ^(2)=15.13,均P<0.001)。观察组胃肠功能恢复时间、住院时间分别为(39.40±8.10)h、(4.33±0.80)d,均短于对照组的(65.70±11.30)h、(6.11±1.13)d,差异均有统计学意义(t=10.26、6.92,均P<0.001)。结论根部坏疽/穿孔性阑尾炎在腹腔镜下采用倒刺线缝合包埋阑尾残端,能够有效缩短阑尾残端缝合包埋时间、降低中转开腹率,减少术后并发症,缩短住院时间,值得基层医院推广。Objective To investigate the efficacy of laparoscopic treatment of gangrenous appendicitis at the base using barbed wire for closure of the residual appendiceal stump.Methods A case-control study was conducted among 58 patients with acute gangrenous appendicitis at the base who were admitted to the Department of General Surgery at Fujian Tingzhou Hospital from January 2018 to December 2022.Based on the type of suture used for burying the residual appendiceal stump during the procedure,the patients were divided into two groups:the control group(n=28,intermittent full-thickness suture embedding of the appendiceal stump using absorbable sutures)and the observation group(n=30,continuous full-thickness suture embedding of the appendiceal stump using barbed sutures).Intraoperative and postoperative related indicators,as well as the incidence of postoperative complications,were compared between the two groups.Results In the observation group,the time for closure of the residual stump was(4.17±0.66)minutes,which was significantly shorter than that in the control group(t=10.98,P<0.001).The rate of conversion rate to open surgery in the observation group was significantly lower than that in the control group[3.33%(1/30)vs.21.42%(6/28),χ^(2)=15.13,P<0.001].The recovery time of gastrointestinal function and the length of hospital stay in the observation group were(39.40±8.10)hours and(4.33±0.80)days,respectively,which were significantly shorter than those in the control group[(65.70±11.30)hours,(6.11±1.13)days,t=10.26,6.92,both P<0.001].Conclusion The use of barbed wire sutures for burying the appendiceal stump in laparoscopic surgery for gangrenous/perforated appendicitis at the base effectively shortens the closure time of the stump,reduces the conversion rate to open surgery,minimizes postoperative complications,and shortens the length of hospital stay,making it a valuable technique for promotion in primary care hospitals.

关 键 词：阑尾炎 腹腔镜检查 阑尾切除术 中转开腹手术 手术时间 住院时间 手术后并发症 

分 类 号：R656.8[医药卫生—外科学]