Levard H, Mouro J, Karayel M, Schiffino L, Berthelot G, Dubois F
Service de Chirurgie Digestive, Hôpital International, Université de Paris.
Ann Chir. 1992;46(5):430-5.
The recent development of laparoscopic surgery has included the treatment of acute appendicitis. We report our results after three years' experience of this type of surgery. We have operated on 78 patients (54 men, 44 women) mean age 28.9 years, suspected of varying degrees of acute appendicitis. The operation was completely carried out by laparoscopy on 71 occasions, including treatment of an abscess in 4 cases and peritonitis in 4 cases (3 of which were sub-mesocolic and one was generalised). The laparoscopy was transformed into laparotomy in 7 cases, 4 of which were due to difficulties of appendix dissection. Mortality was zero. Four complications occurred: 2 minute infections of the trocar hole, one more severe parietal infection which was a cause of readmission and antibiotic treatment, one "syndrome of the fifth day". In conclusion, laparoscopic appendicectomy appears to be quite feasible in the majority of cases, particularly when the appendix is ectopic, with marked abdominal thickening and peritoneal reaction. The postoperative course is uneventful. The laparoscopic technique is very comfortable for the patient during the postoperative period. This technique is becoming increasingly feasible with the operator's experience, and this appears to us to constitute good training for any form of laparoscopic surgery.
腹腔镜手术的最新进展包括对急性阑尾炎的治疗。我们报告了三年来这类手术的经验及结果。我们对78例（54例男性，44例女性）平均年龄28.9岁、疑似不同程度急性阑尾炎的患者进行了手术。71例手术完全通过腹腔镜完成，其中包括4例脓肿治疗和4例腹膜炎治疗（3例为结肠系膜下型，1例为弥漫性）。7例手术由腹腔镜转为开腹手术，其中4例是由于阑尾解剖困难。死亡率为零。发生了4例并发症：2例穿刺孔轻微感染，1例更严重的腹壁感染导致再次入院并接受抗生素治疗，1例“第五天综合征”。总之，腹腔镜阑尾切除术在大多数情况下似乎相当可行，尤其是当阑尾异位、腹部明显增厚和有腹膜反应时。术后病程平稳。腹腔镜技术在术后对患者来说非常舒适。随着术者经验的增加，这项技术越来越可行，在我们看来，这对任何形式的腹腔镜手术都是很好的训练。
