阑尾根部双平面丝线结扎联合阑尾系膜完全电凝切断技术在腹腔镜阑尾切除术中的应用  

Application of double-plane silk thread ligation at the root of the appendix combined with complete electrical coagulation of the mesoappendix in laparoscopic appendectomy

作　　者：崔周军[1] 简淑 李建钦 张凯 宋玉伟 李洪波[1] CUI Zhoujun;JIAN Shu;LI Jianqin(Department of General Surgery,People's Hospital of Rizhao,Rizhao 276800,China;Department of General Surgery,Qianjiang Central Hospital of Chongqing;Department of General Surgery,Juxian Hospital of Traditional Chinese Medicine)

机构地区：[1]日照市人民医院普通外科,山东日照276800 [2]重庆市黔江中心医院普通外科 [3]日照市莒县中医医院普通外科

出　　处：《腹腔镜外科杂志》2024年第10期769-773,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜阑尾切除术中采用阑尾根部双平面丝线结扎联合阑尾系膜完全电凝切断技术的安全性及价值。方法:回顾分析2020年12月至2022年12月为189例急性阑尾炎患者行腹腔镜阑尾切除术的临床资料,丝线结扎组术中阑尾系膜应用单极电凝钩电凝模式自阑尾头端紧贴阑尾浆膜切断,2-0丝线距阑尾根部约0.3 cm处行第一平面结扎,距第一平面约0.2 cm处用2-0丝线行第二平面结扎;血管夹夹闭组阑尾系膜电凝钩分离后用Hem-o-lok夹闭,根部游离后用Hem-o-lok双重夹闭。对比分析两组相关指标。结果:两组患者均顺利完成腹腔镜阑尾切除术,无中转开腹。两组患者性别、年龄、基础疾病、术前白细胞计数、术后并发症发生率差异无统计学意义(P>0.05)。丝线结扎组与血管夹夹闭组入院时体温[(37.88±0.84)℃vs.(37.59±0.74)℃]、手术时间[(52.36±15.25)min vs.(70.99±25.85)min]、术中出血量[(5.12±1.91)mL vs.(14.53±8.38)mL]、耗材费用[0(0,0)元vs. 444(444,444)元]、住院时间[(4.05±1.53)d vs.(5.89±1.51)d]、术后病理检查结果差异均有统计学意义。结论:腹腔镜阑尾切除术中应用双平面丝线结扎处理阑尾根部、完全电凝切断阑尾系膜可缩短手术时间、住院时间,降低术中出血量及耗材费用,安全、可行,值得推广。Objective:To investigate the safety and value of double-plane silk thread ligation at the root of the appendix combined with complete electrical coagulation of the mesoappendix in laparoscopic appendectomy.Methods:Clinical data of 189 patients with acute appendicitis who underwent laparoscopic appendectomy from Dec.2020 to Dec.2022 were retrospectively analyzed.The patients in the silk thread ligation group were treated with a single-pole electric coagulation hook,the mesoappendix was resected close to the appendix serosa from the head of the appendix.The first plane ligation was performed at a distance of about 0.3 cm from the root of the appendix with 2-0 silk thread,and the second plane was ligated with 2-0 silk thread at about 0.2 cm away from the first plane.The clamped group used Hem-o-lok clamps to close the mesoappendix after separation of the mesoappendix by electric coagulation hook,and appendix root was closed by Hem-o-lok double clamps after separation.Clinical data of the two groups were compared and analyzed.Results:Both groups successfully completed laparoscopic appendectomy without conversion to open surgery.There was no significant diffe-rence in sex,age,background diseases,preoperative white blood cell count,and postoperative complications between the two groups(P>0.05).However,the body temperature at admission[(37.88±0.84)℃vs.(37.59±0.74)℃],operative time[(52.36±15.25)min vs.(70.99±25.85)min],intraoperative blood loss[(5.12±1.91)mL vs.(14.53±8.38)mL],cost of consumables[0(0,0)yuan vs.444(444,444)yuan],hospital stay[(4.05±1.53)d vs.(5.89±1.51)d],postoperative pathological examination results in silk thread ligation group and clamped group were statistically different.Conclusions:The application of double-plane silk thread ligating the root of appendix and electric coagulation of the mesoappendix in laparoscopic appendectomy can decrease the operation time,hospital stay,intraoperative blood loss and consumable cost,which is safe,feasible and worthy of promotion.

关 键 词：急性阑尾炎 阑尾切除术 腹腔镜检查 阑尾根部 阑尾系膜 

分 类 号：R656.8[医药卫生—外科学]