腹腔镜手术应用于复杂阑尾炎治疗中的临床效果
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摘要
目的研究并探讨腹腔镜手术应用于坏疽及(或)根部穿孔等复杂阑尾炎患者的临床效果。方法选择2013年8月~2018年1月收治的80例成人坏疽及(或)根部穿孔的阑尾炎患者,进行回顾性分析研究,按照随机数字表法将其分为观察组和对照组,每组40例。观察组为实施完全腹腔镜阑尾切除术患者,对照组为实施开腹阑尾切除术及腹腔镜中转开腹的患者。比较两组手术情况、并发症发生率、术后恢复时间。结果在手术时间、手术切口长度、术中出血量等方面比较,差异有统计学意义(P <0.05)。在预防术后阑尾残端瘘的发生、切口感染、腹腔脓肿及远期切口疝形成等方面,差异有统计学意义(P <0.05)。组间术后排气恢复时间、住院时间比较,观察组均短于对照组,差异有统计学意义(P <0.05)。结论治疗坏疽及(或)根部穿孔等复杂、严重阑尾炎病例时采用完全腹腔镜的方式比传统开放手术及腹腔镜中转改开放切除的患者,除具有腹腔镜手术创伤轻、术后并发症少、术后恢复快等优势外,更重要的是能明显减少术后阑尾残端瘘的发生、降低因瘘而导致的切口感染、腹腔脓肿及远期切口疝形成。
Objective To study and explore the clinical curative effect of laparoscopic surgery in the treatment of complex appendicitis such as gangrene and root perforation. Methods 80 patients with gangrene and root perforation who were admitted and treated in our hospital from August 2013 to January 2018 were selected and retrospectively analyzed.According to the random number table method,they were divided into the observation group and the control group,with 40 cases in each group.The observation group was treated with laparoscopic appendectomy while the control group was treated with open appendectomy and laparoscopic conversion to laparotomy.The operation status,complication rate and postoperative recovery time of the two groups were compared. Results There were statistically significant differences between the two groups in terms of operation time,length of surgical incision and intraoperative blood loss(P < 0.05).There were statistically significant differences between the two groups in the prevention of postoperative appendiceal stump fistula,incision infection,abdominal abscess and long-term incisional hernia formation(P < 0.05).The recovery time of postoperative exhaust and hospital stay were shorter in the observation group than in the control group(P < 0.05). Conclusion In the treatment of cases of gangrene,root perforation and severe appendicitis,complete laparoscopic approach has the advantages of less trauma,fewer postoperative complications and quick postoperative recovery compared with traditional open appendectomy and laparoscopic conversion to laparotomy.More importantly,it can significantly reduce the occurrence of postoperative appendiceal stump fistula,reduce the infection caused by sputum,abdominal abscess and long-term incisional hernia.
Objective To study and explore the clinical curative effect of laparoscopic surgery in the treatment of complex appendicitis such as gangrene and root perforation. Methods 80 patients with gangrene and root perforation who were admitted and treated in our hospital from August 2013 to January 2018 were selected and retrospectively analyzed.According to the random number table method,they were divided into the observation group and the control group,with 40 cases in each group.The observation group was treated with laparoscopic appendectomy while the control group was treated with open appendectomy and laparoscopic conversion to laparotomy.The operation status,complication rate and postoperative recovery time of the two groups were compared. Results There were statistically significant differences between the two groups in terms of operation time,length of surgical incision and intraoperative blood loss(P < 0.05).There were statistically significant differences between the two groups in the prevention of postoperative appendiceal stump fistula,incision infection,abdominal abscess and long-term incisional hernia formation(P < 0.05).The recovery time of postoperative exhaust and hospital stay were shorter in the observation group than in the control group(P < 0.05). Conclusion In the treatment of cases of gangrene,root perforation and severe appendicitis,complete laparoscopic approach has the advantages of less trauma,fewer postoperative complications and quick postoperative recovery compared with traditional open appendectomy and laparoscopic conversion to laparotomy.More importantly,it can significantly reduce the occurrence of postoperative appendiceal stump fistula,reduce the infection caused by sputum,abdominal abscess and long-term incisional hernia.
引文
[1]黎雪秋.开腹与腹腔镜阑尾切除术治疗急性坏疽性阑尾炎伴弥漫性腹膜炎的临床疗效对比[J].医学理论与实践,2015,28(5):626-627.
[2]姜海毅,丁红光,常成,等.腹腔镜下阑尾切除术治疗坏疽性阑尾炎[J].临床普外科电子杂志,2015,3(4):15-19.
[3]上官士斌.腹腔镜手术治疗急性坏疽性阑尾炎的疗效及安全性评价[J].世界临床医学,2017,11(13):51.
[4]宋辉.急性坏疽穿孔性阑尾炎50例的手术治疗体会[J].中国伤残医学,2015,23(6):71-72.
[5]庞永奎.腹腔镜与开腹阑尾切除术治疗急性穿孔性阑尾炎的疗效对照分析[J].中华普通外科学文献(电子版),2015,9(6):491-493.
[6]万里鹏,万鸿,吴安定,等.腹腔镜治疗伴有坏疽、穿孔及阑尾周围脓肿的复杂性阑尾炎的优势探讨[J].安徽医药,2015,19(5):946-947.
[7]张弦,徐继宗,付广,等.腹腔镜阑尾切除术与开腹手术的对比研究[J].中国微创外科杂志,2015,15(9):798-800.
[8]阙长榕,许东波,林双明,等.512例腹腔镜阑尾切除术的临床分析[J].中国医师进修杂志,2015,38(7):471-475.
[9]王东君,张新元,张震波,等.腹腔镜阑尾切除术治疗急性坏疽穿孔性阑尾炎[J].中国微创外科杂志,2016,16(4):380-381.
[10]艾常华,潘晟,陶艳娥,等.O形缝扎法在根部坏疽性阑尾炎腹腔镜手术中的应用[J].腹腔镜外科杂志,2017,22(6):476-478.
[11]李春生,刘铜军,申震,等.腹腔镜阑尾切除术与开腹阑尾切除术的临床对比研究[J].中华普通外科杂志,2015,30(8):647-649.
[12]汤浩,孙键,吴登峰,等.腹腔镜下阑尾切除术与开腹阑尾切除术在穿孔性阑尾炎中的疗效及安全性分析[J].河北医药,2016,38(9):1318-1320.
[13]王勇,彭永光,李奕瑾,等.开腹与腹腔镜阑尾切除术治疗穿孔性阑尾炎的临床效果比较[J].临床军医杂志,2015,43(1):10-13.
[14]黎雪秋.开腹与腹腔镜阑尾切除术治疗急性坏疽性阑尾炎伴弥漫性腹膜炎的临床疗效对比[J].医学理论与实践,2015,28(5):626-627.
[15]田毅波,李树峰,徐峰,等.急性坏疽性阑尾炎伴弥漫性腹膜炎患者腹腔镜与开腹阑尾切除术的疗效比较[J].山西医药杂志,2014,45(7):809-811.
[2]姜海毅,丁红光,常成,等.腹腔镜下阑尾切除术治疗坏疽性阑尾炎[J].临床普外科电子杂志,2015,3(4):15-19.
[3]上官士斌.腹腔镜手术治疗急性坏疽性阑尾炎的疗效及安全性评价[J].世界临床医学,2017,11(13):51.
[4]宋辉.急性坏疽穿孔性阑尾炎50例的手术治疗体会[J].中国伤残医学,2015,23(6):71-72.
[5]庞永奎.腹腔镜与开腹阑尾切除术治疗急性穿孔性阑尾炎的疗效对照分析[J].中华普通外科学文献(电子版),2015,9(6):491-493.
[6]万里鹏,万鸿,吴安定,等.腹腔镜治疗伴有坏疽、穿孔及阑尾周围脓肿的复杂性阑尾炎的优势探讨[J].安徽医药,2015,19(5):946-947.
[7]张弦,徐继宗,付广,等.腹腔镜阑尾切除术与开腹手术的对比研究[J].中国微创外科杂志,2015,15(9):798-800.
[8]阙长榕,许东波,林双明,等.512例腹腔镜阑尾切除术的临床分析[J].中国医师进修杂志,2015,38(7):471-475.
[9]王东君,张新元,张震波,等.腹腔镜阑尾切除术治疗急性坏疽穿孔性阑尾炎[J].中国微创外科杂志,2016,16(4):380-381.
[10]艾常华,潘晟,陶艳娥,等.O形缝扎法在根部坏疽性阑尾炎腹腔镜手术中的应用[J].腹腔镜外科杂志,2017,22(6):476-478.
[11]李春生,刘铜军,申震,等.腹腔镜阑尾切除术与开腹阑尾切除术的临床对比研究[J].中华普通外科杂志,2015,30(8):647-649.
[12]汤浩,孙键,吴登峰,等.腹腔镜下阑尾切除术与开腹阑尾切除术在穿孔性阑尾炎中的疗效及安全性分析[J].河北医药,2016,38(9):1318-1320.
[13]王勇,彭永光,李奕瑾,等.开腹与腹腔镜阑尾切除术治疗穿孔性阑尾炎的临床效果比较[J].临床军医杂志,2015,43(1):10-13.
[14]黎雪秋.开腹与腹腔镜阑尾切除术治疗急性坏疽性阑尾炎伴弥漫性腹膜炎的临床疗效对比[J].医学理论与实践,2015,28(5):626-627.
[15]田毅波,李树峰,徐峰,等.急性坏疽性阑尾炎伴弥漫性腹膜炎患者腹腔镜与开腹阑尾切除术的疗效比较[J].山西医药杂志,2014,45(7):809-811.