腹腔镜系膜剥离法阑尾切除术与腹腔镜常规阑尾切除术的对比研究

来源:用户上传      作者:

　　[摘要] 目的 探讨腹腔镜系膜剥离法阑尾切除术的临床应用价值。方法 方便选取该院接收的68例阑尾炎患者，时间为2017年5月—2018年5月期间，将入选者随机分为对照组（n=34，采取腹腔镜常规阑尾切除）与观察组（n=34，采取腹腔镜系膜剥离法阑尾切除术），对手术相关指标进行观察。结果 观察组手术时间为（43.21±11.45）min明显缩短，与对照组比较差异有统计学意义（t=-3.28，P<0.05），两组总住院费用及住院时间比较基本一致（P>0.05）;观察组标本从Trocar取出率76.47%较对照组明显要高（χ2=34.39，P<0.05）;活动性出血率5.88%较对照组明显要低（χ2=6.67，P<0.05）;两组均未出现肠瘘、肠梗阻及大出血病例。两组穿刺口感染率及盆腔感染率比较差异无统计学意义（P>0.05）。结论 对急性阑尾患者采取腹腔镜系膜剥离法阑尾切除术治疗，能有效减少术中出血，缩短手术操作时间，相比于腹腔镜常规阑尾切除术，其临床优势明显，值得推广。
　　[关键词] 阑尾切除术;腹腔镜;系膜剥离法
　　[中图分类号] R656          [文献标识码] A          [文章编号] 1674-0742（2019）09（a）-0042-03
　　[Abstract] Objective To evaluate the clinical value of laparoscopic mesoreliectomy for appendectomy. Methods 68 patients with appendicitis were convenient selected and enrolled in this hospital. The patients were randomly divided into the control group （n=34， laparoscopic conventional appendectomy） and the observation group （n=34， laparoscopic membranous exfoliation appendectomy） from May 2017 to May 2018， observation of surgical related indicators. Results The operation time of the observation group was （43.21±11.45） min， which was significantly shorter than that of the control group，and the difference was statistically significant（t=-3.28， P<0.05）. The total hospitalization cost and hospitalization time of the two groups were basically the same （P>0.05）. The removal rate of the specimen from the Trocar was 76.47% higher than that of the control group（χ2=34.39， P<0.05）; the active bleeding rate was 5.88% lower than that of the control group （χ2=6.67， P<0.05）; neither group nor cases of intestinal fistula， intestinal obstruction， and major bleeding. There was no statistically significant difference in the infection rate and pelvic infection rate between the two groups （P>0.05）. Conclusion Laparoscopic detachment of appendectomy in patients with acute appendix can effectively reduce intraoperative bleeding and shorten the operation time. Compared with laparoscopic conventional appendectomy， its clinical advantage is obvious and worthy of promotion.
　　[Key words] Appendectomy; Laparoscopy; Mesodeping
　　腹腔镜下阑尾切除目前在临床上已广泛开展，相比于开腹阑尾切除术具有明显的优势，具有切口美观、并发症少、手术恢复快等优点。但目前腹腔镜阑尾切除术手术步骤，多沿用开腹手术的步骤，即先将阑尾根部系膜血管离断，再一并取出阑尾及系膜，但对于严重肿胀的阑尾，往往难以从Trocar内或穿刺孔中取出，同时在系膜水肿或局部粘连较重时，腔镜下操作角度较难调整，分离阑尾根部系膜難度较大，容易损伤血管和周围组织。为解决以上问题，该院于2017年5月—2018年5月期间对68例阑尾炎患者尝试行系膜剥离法阑尾切除术，即先将系膜顺行剥离至阑尾根部后，再进行阑尾切除，手术取得较满意的效果，现将内容报道如下。
　　1  资料与方法
　　1.1  一般资料
转载注明来源:https://www.xzbu.com/6/view-15043367.htm