發(fā)布時(shí)間：2018-04-19 08:07

  本文選題：懸吊式免氣腹 + 腹腔鏡闌尾切除術(shù)��； 參考：《蘇州大學(xué)》2014年碩士論文

【摘要】：【目的】 選取免氣腹（gasless laparoscopic appendectomy，GLA）、傳統(tǒng)腹腔鏡闌尾切除術(shù)（laparoscopic appendectomy，LA）以及開腹闌尾切除術(shù)（open appendectomy，OA）各100例，通過分析其術(shù)前準(zhǔn)備時(shí)間、手術(shù)時(shí)間、術(shù)中出血量、切口長度、術(shù)后腸道恢復(fù)時(shí)間、住院時(shí)間、住院費(fèi)用、術(shù)后并發(fā)癥等的指標(biāo)差異，評(píng)價(jià)三種闌尾切除手術(shù)方法的優(yōu)缺點(diǎn)，并探討免氣腹腹腔鏡闌尾切除術(shù)在臨床工作中的可行性。 【方法】 選取2012年06月-2014年08月在腰硬聯(lián)合麻醉下懸吊式免氣腹腹腔鏡闌尾切除術(shù)100例，與同期腰硬聯(lián)合麻醉下傳統(tǒng)腹腔鏡闌尾切除術(shù)及開腹闌尾切除術(shù)各100例進(jìn)行回顧性對(duì)比分析，比較三者之間術(shù)前準(zhǔn)備時(shí)間、平均手術(shù)時(shí)間、術(shù)中平均出血量、切口長度、術(shù)后腸道功能恢復(fù)時(shí)間、住院時(shí)間、住院費(fèi)用、術(shù)后并發(fā)癥等指標(biāo)的差異。 【結(jié)果】 三組入院病人均成功完成手術(shù)，腹腔鏡手術(shù)組無中轉(zhuǎn)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CO2氣體栓塞等并發(fā)癥發(fā)生。 術(shù)前準(zhǔn)備時(shí)間：免氣腹腹腔鏡闌尾切除組6.5±3.4min，較其它二組長，均具有統(tǒng)計(jì)學(xué)差異（相比傳統(tǒng)腹腔鏡組3.5±1.6min，P＜0.05；相比開腹組2.5±1.8min，P＜0.05）。 術(shù)中出血量：免氣腹腔鏡組為4.0±1.4ml；相比傳統(tǒng)腹腔鏡組4.3±1.2ml，P0.05，兩組之間差異無統(tǒng)計(jì)學(xué)意義；相比開腹組15.3±1.8ml，P＜0.05，兩組之間差異有統(tǒng)計(jì)學(xué)意義。 手術(shù)實(shí)際操作時(shí)間：免氣腹腔鏡組34.5±7.6min，相比傳統(tǒng)腹腔鏡組30.3±5.7min，P0.05，兩組之間差異無統(tǒng)計(jì)學(xué)意義；相比開腹手術(shù)組42.3±7.3min，P＜0.05，兩組之間差異有統(tǒng)計(jì)學(xué)意義。 手術(shù)切口長度：免氣腹腔鏡組2.5±0.9cm，相比傳統(tǒng)腹腔鏡組2.5±0.5cm，P0.05，兩組之間差異無統(tǒng)計(jì)學(xué)意義；相比開腹手術(shù)組5.5±1.4cm，P＜0.05，兩組之間差異有統(tǒng)計(jì)學(xué)意義。 平均腸道功能恢復(fù)時(shí)間：免氣腹腔鏡組17.1±7.0小時(shí)，傳統(tǒng)腹腔鏡組23.5±1.6小時(shí)，P＜0.05，兩組之間差異有統(tǒng)計(jì)學(xué)意義。相比于開腹手術(shù)30.2±6.6小時(shí)，P＜0.05，兩組之間差異有統(tǒng)計(jì)學(xué)意義。 術(shù)后切口感染率：免氣腹腔鏡組3%，相比傳統(tǒng)腹腔鏡組4%，P0.05，兩組之間差異無統(tǒng)計(jì)學(xué)意義；相比于開腹手術(shù)11%，P＜0.05，兩組之間差異有統(tǒng)計(jì)學(xué)意義。 術(shù)后肩頸痛情況:免氣腹腔鏡組3.0±1.0例，相比傳統(tǒng)腹腔鏡組16.0±2.0例，P＜0.05，兩組之間差異有統(tǒng)計(jì)學(xué)意義。；相比于開腹手術(shù)2.0±1.0例，P0.05，兩組之間差異無統(tǒng)計(jì)學(xué)意義。 術(shù)后上腹部疼痛情況：免氣腹腔鏡組2.0±1.0例，相比傳統(tǒng)腔鏡組30.0±7.0例，P＜0.05，兩組之間差異有統(tǒng)計(jì)學(xué)意義。；相比于開腹手術(shù)12.0±4.0例，P＜0.05，兩組之間差異無統(tǒng)計(jì)學(xué)意義。 術(shù)后嘔吐：免氣腹腔鏡組20±5.0例，相比傳統(tǒng)腹腔鏡組50±7.0例，P＜0.05，兩組之間差異有統(tǒng)計(jì)學(xué)意義，相比開腹手術(shù)40±5.0例，P＜0.05，兩組之間差異有統(tǒng)計(jì)學(xué)意義. 總住院時(shí)間：免氣腹腔鏡組2.5±0.5天，相比傳統(tǒng)腹腔鏡組4.0±0.5天，，P＜0.05，兩組之間差有無統(tǒng)計(jì)學(xué)意義；相比于開腹手術(shù)7.5±1.5天，P＜0.05，兩組之間差異有統(tǒng)計(jì)學(xué)意義。 住院費(fèi)用：免氣腹腔鏡組6512.24±512.09元，傳統(tǒng)腹腔鏡組7004.45±623.43元，，P＜0.05，兩組之間差異有統(tǒng)計(jì)學(xué)意義 【結(jié)論】 ①懸吊式免氣腹裝置安裝，稍增加了術(shù)前準(zhǔn)備時(shí)間； ②免氣腹腹腔鏡下手術(shù)切口感染率明顯低于開腹組； ③免氣腹腹腔鏡手術(shù)無人工氣腹相關(guān)并發(fā)癥發(fā)生，術(shù)后腸道恢復(fù)情況均優(yōu)于傳統(tǒng)腹腔鏡組和開腹組； ④免氣腹腹腔鏡手術(shù)術(shù)后肩頸疼痛及上腹部疼痛發(fā)生率低于傳統(tǒng)腹腔鏡組及開腹組； ⑤免氣腹腹腔鏡闌尾切除術(shù)可以無需全麻，在連續(xù)硬膜外麻醉下實(shí)施。其所采用技術(shù)、器械要求相對(duì)簡單，能避免氣腹的不良反應(yīng)，又行微創(chuàng)闌尾切除手術(shù)，便于在基層臨床中推廣應(yīng)用。
[Abstract]:[Objective]
Select (gasless laparoscopic appendectomy, gasless GLA) and conventional laparoscopic appendectomy (laparoscopic appendectomy, LA) and open appendectomy (open appendectomy, OA) of the 100 cases, through the analysis of the preoperative preparation time, operation time, blood loss, intraoperative incision length, postoperative intestinal recovery time, hospitalization time and the cost of hospitalization, postoperative complications and other indicators of differences, advantages and disadvantages of three evaluation methods for resection of appendix, and discuss the feasibility of gasless laparoscopic appendectomy in the clinical work.
[method]
From 2012 06 months -2014 years 08 months in the combined spinal epidural anesthesia gasless laparoscopic appendectomy in 100 cases, with the same period of combined spinal epidural anesthesia for laparoscopic appendectomy and conventional appendectomy in 100 cases were retrospectively analyzed and compared between the three groups preoperative preparation time, average operation time. The average amount of bleeding, intraoperative incision length, postoperative intestinal function recovery time, hospitalization time, hospitalization costs, difference complications after operation.
[results]
Three groups of patients were successfully completed surgery, laparoscopic surgery group without conversion to open surgery, no abdominal wall, blood vessels, abdominal visceral injuries, no subcutaneous hematoma and bleeding, no acid poisoning, pneumothorax and CO2 gas embolism and other complications.
Preoperative preparation time: gasless laparoscopic appendectomy group 6.5 + 3.4min, compared with the other two group leader, all had statistical difference (compared with the traditional laparoscopic group 3.5 + 1.6min, P < 0.05), compared with the open group, 2.5 + 1.8min, P < 0.05.
The amount of bleeding during operation: the gas free laparoscopic group was 4 + 1.4ml; compared with the traditional laparoscopic group, the difference between the two groups was not statistically significant (4.3 + 1.2ml, P0.05); compared with the open group, 15.3 + 1.8ml, P < 0.05, the difference between the two groups was statistically significant.
The actual operative time of operation was 34.5 + 7.6min in the free gas laparoscopy group, compared with 30.3 in the traditional laparoscopic group and two in the P0.05 group. The difference between the two groups was not statistically significant. Compared with the open operation group, 42.3 + 7.3min and P < 0.05, the difference between the two groups was statistically significant.
The length of operative incision was 2.5 + 0.9CM in the air free laparoscopic group. There was no significant difference between the two groups in comparison with the conventional laparoscopy group (2.5 + 0.5cm, P0.05). Compared with the laparotomy group, the difference between the two groups was statistically significant (5.5 + 1.4cm) and P < 0.05.
The average recovery time of intestinal function was 17.1 + 7 hours in the gasless laparoscopic group and 23.5 + 1.6 hours in the traditional laparoscopy group, P < 0.05. The difference between the two groups was statistically significant. Compared with the open operation, 30.2 and 6.6 hours, P < 0.05, there was a significant difference between the two groups.
Postoperative incision infection rate: 3% in the free gas laparoscopic group, compared with 4% in the traditional laparoscopic group, P0.05, there was no significant difference between the two groups, compared with laparotomy 11%, P < 0.05, the difference between the two groups was statistically significant.
The shoulder and neck pain after operation: the air free laparoscopic group was 3 + 1 cases, compared with the traditional laparoscopic group 16 + 2 cases, P < 0.05, the difference between the two groups was statistically significant. Compared with the open surgery 2 + 1 cases, there was no significant difference between P0.05 and two groups.
Postoperative pain in upper abdomen: 2 + 1 cases in the free gas laparoscopic group, 30 + 7 cases in the traditional endoscopic group, P < 0.05, the difference between the two groups was statistically significant. Compared with the open operation 12 + 4 cases, P < 0.05, there was no significant difference between the two groups.
Postoperative vomiting: 20 patients in the free gas laparoscopy group (5 cases), compared with 50 cases in the traditional laparoscopic group (P < 0.05), the difference between the two groups was statistically significant. Compared with the open operation, 40 cases were 5 cases, P < 0.05, and the difference between the two groups was statistically significant.
The total length of stay was 2.5 + 0.5 days in the free gas laparoscopic group compared with 4 days in the traditional laparoscopic group (P < 0.05). There was no significant difference in the difference between the two groups (P < 0.05) compared with the open operation, and the difference between the two groups was statistically significant.
The cost of hospitalization: 6512.24 + 512.09 yuan for free laparoscopic group and 7004.45 + 623.43 yuan in traditional laparoscopy group, P < 0.05. The difference between the two groups was statistically significant.
[Conclusion]
The installation of the suspension free pneumoperitoneum has slightly increased the preparation time before the operation;
(2) the infection rate of the incision without pneumoperitoneum was significantly lower than that of the laparotomy group.
There were no complications associated with pneumoperitoneum in pneumoperitoneum, and the postoperative recovery of intestinal tract was better than that of the traditional laparoscopy group and the laparotomy group.
(4) the incidence of shoulder and neck pain and upper abdominal pain after pneumoperitoneo laparoscopic surgery was lower than that of the traditional laparoscopy group and the laparotomy group.
Pneumoperitoneum laparoscopic appendectomy can be performed without epidural anesthesia under continuous epidural anesthesia. The technique is simple and can avoid adverse reactions of pneumoperitoneum and minimally invasive appendectomy. It is convenient for popularization and application in primary clinical practice.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R656.8

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 高毅,楊繼震,俞金龍,楊軍,劉春曉,周興;扇形腹壁懸吊器在免氣腹腹腔鏡手術(shù)中的應(yīng)用[J];第一軍醫(yī)大學(xué)學(xué)報(bào);1997年02期

2 馬海蘭;蘭雪琴;;懸吊式免氣腹腹腔鏡手術(shù)在婦科的臨床進(jìn)展[J];腹腔鏡外科雜志;2008年04期

3 潘建輝;腹腔鏡外科圍術(shù)期并發(fā)癥及其防治[J];國外醫(yī)學(xué).麻醉學(xué)與復(fù)蘇分冊(cè);1994年04期

4 黃習(xí)忠;;腹腔鏡治療壞疽穿孔性闌尾炎21例報(bào)告[J];廣西醫(yī)學(xué);2007年05期

5 趙宗彥;;LC術(shù)中CO_2氣腹前后患者呼吸、循環(huán)及血?dú)庵笜?biāo)變化及意義[J];山東醫(yī)藥;2007年35期

6 王宏宇;史宏偉;徐磊;;氣腹時(shí)恒定潮氣量通氣對(duì)手術(shù)患者呼吸動(dòng)態(tài)參數(shù)的影響[J];山東醫(yī)藥;2008年28期

7 龔建軍;梁亞萍;牛建華;;不同氣腹壓力對(duì)腹腔鏡膽囊切除術(shù)凝血-纖溶指標(biāo)的影響[J];臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志;2013年06期

8 阮景德,張曉波,夏征,張成裕,劉恕;腹壁提升免氣腹腹腔鏡手術(shù)[J];中國內(nèi)鏡雜志;2001年03期

9 夏征 ,阮景德 ,張曉波;自制腹壁提升器在老年人免氣腹腹腔鏡手術(shù)中的應(yīng)用[J];中國內(nèi)鏡雜志;2002年03期

10 亓玉忠,胡三元,張建良,于文濱,王培林;腹腔鏡闌尾切除術(shù)的應(yīng)用價(jià)值[J];中國內(nèi)鏡雜志;1999年03期

本文編號(hào)：1772266