【摘要】：[目的] 通過對比分析免氣腹腹腔鏡闌尾切除術(gasless laparoscopic appendectomy, GLA)和傳統(tǒng)腹腔鏡闌尾切除術(laparoscopic appendectomy, LA)的術中及術后的指標差異,來探討免氣腹腹腔鏡闌尾切除術在日常臨床工作中的可行性。 [方法] 搜集上海第九人民醫(yī)院奉城分院普外科2012年06月至2013年12月在腰硬聯(lián)合麻醉下行懸吊式免氣腹腹腔鏡闌尾切除術的患者30例,與同期腰硬聯(lián)合麻醉下傳統(tǒng)腹腔鏡闌尾切除術患者30例的資料進行對比分析,比較兩組平均手術時間、術中平均出血量、術后腸道功能恢復時間、住院時間及術后并發(fā)癥等指標。 [結果] 兩組均成功完成手術,無中轉開腹,無腹壁、血管、腹腔內(nèi)臟器損傷,無皮下血腫及出血,無酸中毒、氣胸和C02氣體栓塞等并發(fā)癥發(fā)生。切口均甲級愈合。比較兩組術前術后血液二氧化碳結合率變化(免氣腹組沒有明顯差異(P0.05),氣腹組存在差異(P0.05)),兩組術中出血量(免氣腹組10.0±12.4毫升,氣腹組8.3±14.2毫升,P0.05)、手術實際操作時間(免氣腹組32.5±7.6分,氣腹組30.3±7.7分,P0.05)及住院時間(免氣腹組3.1±1.1天,氣腹組3.2±0.9天,P0.05)等,兩組差異均無統(tǒng)計學意義；比較兩組術前準備時間(免氣腹組10.5±3.6min,氣腹組3.5±1.6min,P0.05).平均腸道功能恢復時間(免氣腹組14.1±4.0小時,氣腹組18.1±4.5小時,P0.05)及術后并發(fā)癥(免氣腹組腹壁疼痛及肩部疼痛例數(shù)明顯少于氣腹組,但存在一例應用克氏針穿刺牽引皮膚,導致該處皮膚組織血腫形成),兩組差異有統(tǒng)計學意義。 [結論] ①免氣腹腹腔鏡闌尾切除術對機體內(nèi)環(huán)境干擾小,基本不影響酸堿平衡及心肺功能,應用于老年患者及原有心肺疾患的急診闌尾炎病人的安全性高； ②免氣腹手術無人工氣腹相關并發(fā)癥發(fā)生,術后腸道恢復情況優(yōu)于氣腹組； ③闌尾手術應用免氣腹技術,手術空間基本足夠,手術視野清晰； ④目前懸吊式免氣腹裝置安裝繁瑣,增加了術前準備時間； ⑤目前懸吊式免氣腹技術牽引腹壁的方式是有創(chuàng)的,存在一定風險。
[Abstract]:[objective] to compare the difference of intraoperative and postoperative indexes between (gasless laparoscopic appendectomy, GLA) and (laparoscopic appendectomy, LA) after pneumoperitoneum laparoscopic appendectomy. To explore the feasibility of pneumoperitoneum-free laparoscopic appendectomy in daily clinical work. [methods] A total of 30 patients with suspension-free laparoscopic appendectomy under combined spinal-epidural anesthesia from June 2012 to December 2013 in Fengcheng Branch of Shanghai Ninth people's Hospital were collected. Compared with 30 cases of traditional laparoscopic appendectomy under combined spinal-epidural anesthesia at the same time, the average operation time, average blood loss, postoperative intestinal function recovery time were compared between the two groups. Hospital stay and postoperative complications. [results] the operation was successfully completed in both groups. There were no complications such as conversion to laparotomy, abdominal wall, blood vessels, injury of abdominal organs, subcutaneous hematoma and hemorrhage, acidosis, pneumothorax and CO2 gas embolism. All incisions healed in grade A. The blood carbon dioxide binding rate before and after operation was compared between the two groups (there was no significant difference between the pneumoperitoneum group and the pneumoperitoneum group (P0.05), but there was a difference between the pneumoperitoneum group and the pneumoperitoneum group (P0.05). In pneumoperitoneum group (8.3 鹵14.2 ml), operative time (32.5 鹵7.6 points in pneumoperitoneum group, 30.3 鹵7.7 minutes in pneumoperitoneum group) and hospitalization time (3.1 鹵1.1 days in pneumoperitoneum group and 3.2 鹵0.9 days in pneumoperitoneum group), there was no significant difference between the two groups. The preparation time before operation was compared between the two groups (10.5 鹵3.6 min in pneumoperitoneum group and 3.5 鹵1.6 min in pneumoperitoneum group). The average recovery time of intestinal function (14.1 鹵4.0 hours in pneumoperitoneum group and 18.1 鹵4.5 hours in pneumoperitoneum group) and postoperative complications (abdominal wall pain and shoulder pain in pneumoperitoneum group were significantly less than those in pneumoperitoneum group, but there was one case of skin traction with Kirschner needle puncture. The difference between the two groups was statistically significant. [conclusion] 1Laparoscopic appendectomy without pneumoperitoneum has little disturbance to the environment of the body and has no effect on the balance of acid-base and cardiopulmonary function. The safety of laparoscopic appendectomy is high in elderly patients and patients with acute appendicitis. (2) there were no complications associated with artificial pneumoperitoneum in pneumoperitoneum operation, and the recovery of intestinal tract after operation was better than that in pneumoperitoneum group. (4) the installation of suspension pneumoperitoneum is complicated at present, which increases the preparation time before operation; (5) the current suspension pneumoperitoneum technique is invasive in drawing the abdominal wall, and there are certain risks.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R656.8

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