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[腹腔镜阑尾切除术残端处理技术及其对手术结局的意义]

[Technique and significance of stump management for outcome of laparoscopic appendectomy].

作者信息

Klima S, Schyra B

机构信息

Chirurgische Klinik, Klinikum Bernburg.

出版信息

Langenbecks Arch Chir Suppl Kongressbd. 1996;113:556-8.

PMID:9101929
Abstract

We compared 140 appendectomies in a prospective study with regard to length of operation, stay in hospital and intra- and postoperative complications. We operated by four methods and made up four groups, 35 patients in each: (1) application of RODER-loop and manual stump-sinking; (2) application of RODER-loop without manual stump-sinking; (3) application of Endo-GIA; (4) conventional appendectomy according to McBurney. Intraoperative complications occurred mainly in laparoscopic appendectomy, while disturbances of wound-healing were observed mainly in conventional appendectomy. The analysis of postoperative complications in laparoscopic appendectomy showed the most complications in the second group (RODER-loop without stump-sinking), while using the Endo-GIA involved only a little risk. In a clear situs the laparoscopic appendectomy with the RODER-loop with manual stump-sinking is recommended; in cases with a difficult preparation or advanced appendicitis the application of the Endo-GIA is a safe technique with the best results.

摘要

在一项前瞻性研究中,我们比较了140例阑尾切除术的手术时长、住院时间以及术中与术后并发症情况。我们采用四种方法进行手术,分为四组,每组35例患者:(1)应用RODER套圈并手动埋入残端;(2)应用RODER套圈但不进行手动埋入残端;(3)应用Endo-GIA;(4)按照麦克伯尼法进行传统阑尾切除术。术中并发症主要发生在腹腔镜阑尾切除术中,而伤口愈合障碍主要见于传统阑尾切除术。对腹腔镜阑尾切除术术后并发症的分析显示,第二组(应用RODER套圈但不埋入残端)并发症最多,而使用Endo-GIA的风险较小。在阑尾位置清晰的情况下,推荐应用带手动埋入残端的RODER套圈进行腹腔镜阑尾切除术;在解剖困难或阑尾炎病情较重的情况下,应用Endo-GIA是一种安全且效果最佳的技术。

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