摘要
目的:探讨单孔腹腔镜联合肾镜阑尾切除术的可行性、优点及应用价值。方法:选择35例腹壁较薄、腹膜刺激征较局限、无下腹部手术史的急、慢性阑尾炎患者,于麦氏点穿刺10mmTrocar,置入腹腔镜,探查腹腔,寻找并证实阑尾炎后更换肾镜,利用肾镜特有的工作通道将阑尾经戳孔拖出,解除气腹后于体外切除。结果:31例成功行单孔腹腔镜联合肾镜阑尾切除术,平均手术时间15min(9～27min),平均出血2.5ml(2～5ml)。术后6h患者可下床活动并进流质饮食。住院2～3d,随访2～29个月,平均19.5个月,无切口感染、术后出血、肠粘连、切口疝等并发症发生。4例因阑尾不能拖出,在脐孔及在下腹分别增加一个Trocar,改行3孔法LA。手术顺利,术后恢复良好,无并发症发生。结论:腹壁较薄、腹膜刺激征较局限、无下腹部手术史的急、慢性阑尾炎患者,行麦氏点单孔腹腔镜联合肾镜阑尾切除术安全,操作简单,患者损伤小,康复快,并发症少,是较为理想的选择。
Objective：To investigate the feasibility,advantages and application value of single port laparoscopic combined with nephroscopic appendectomy. Methods ： Thirty-five patients with acute or chronic appendicitis were selected, their abdominal wall was thin,peritoneal irritation sign was localized and with no history of hypogastrium surgery. 10mm Trocar was punctured at McBurney point,laparoscope was inserted into abdomen. When appendix was found and appendicitis was confirmed, nephroseope was inserted into abdominal cavity instead of laparoscope. Appendix was pulled out through incision in the help of special nephroscopie working channel. The pneumoperitoneum was withdrawn and appendix was excised out of abdominal cavity. Results：Thirty-one cases single port laparo- scopic combined with nephroseopic assisted appendectomy were successful. Mean operating time was 15min （range 9-27 ） , mean blood loss was 2.5ml （ range 2-5 ）. Patients could walk freely and take liquid diet 6h after surgical procedures. Hospital stay was 2-3d. Mean follow up was 19.5 months （range 2-29 months）,and none of the patients complained of incision infection,postoperative hemorrhage, intestinal adhesion,incision hernia or other complications. 4 patients whose appendix could not be pulled out underwent 3 ports laparo- scopic appendectomy,with 2 additional Trocar at umbilicus and left lower quadrant respectively. Their operations were successful, pa- tients recovered well without complications. Conclusions：Single port laparoscopic combined with nephroscopic appendectomy is safe for patients with acute or chronic appendicitis, thin abdominal wall,localized peritoneal irritation sign and no history of hypogastrium surgery. It is an ideal choice with simple procedure,little trauma,quick recovery and few complications.
出处
《腹腔镜外科杂志》
2010年第1期20-22,共3页
Journal of Laparoscopic Surgery
