【摘要】：[目的] 通過對比分析免氣腹腹腔鏡闌尾切除術(shù)(gasless laparoscopic appendectomy, GLA)和傳統(tǒng)腹腔鏡闌尾切除術(shù)(laparoscopic appendectomy, LA)的術(shù)中及術(shù)后的指標(biāo)差異,來探討免氣腹腹腔鏡闌尾切除術(shù)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(shù)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(shù)患者30例的資料進行對比分析,比較兩組平均手術(shù)時間、術(shù)中平均出血量、術(shù)后腸道功能恢復(fù)時間、住院時間及術(shù)后并發(fā)癥等指標(biāo)。 [結(jié)果] 兩組均成功完成手術(shù),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(shù)前術(shù)后血液二氧化碳結(jié)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(shù)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(shù)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(xué)意義；比較兩組術(shù)前準(zhǔn)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(fù)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(shù)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(yīng)用克氏針穿刺牽引皮膚,導(dǎo)致該處皮膚組織血腫形成),兩組差異有統(tǒng)計學(xué)意義。 [結(jié)論] ①免氣腹腹腔鏡闌尾切除術(shù)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(yīng)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(shù)無人工氣腹相關(guān)并發(fā)癥發(fā)生,術(shù)后腸道恢復(fù)情況優(yōu)于氣腹組； ③闌尾手術(shù)應(yīng)用免氣腹技術(shù),手術(shù)空間基本足夠,手術(shù)視野清晰； ④目前懸吊式免氣腹裝置安裝繁瑣,增加了術(shù)前準(zhǔn)備時間； ⑤目前懸吊式免氣腹技術(shù)牽引腹壁的方式是有創(chuàng)的,存在一定風(fēng)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(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R656.8

【參考文獻】

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;1997年02期

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

3 繆小飛;王彤;;二氧化碳氣腹對生理功能的影響[J];腹腔鏡外科雜志;2010年01期

4 黃政通;江偉航;黃芳;梁健華;;二氧化碳氣腹在腹腔鏡膽囊切除術(shù)中對心肺功能的影響[J];河北醫(yī)學(xué);2006年08期

5 趙宗彥;;LC術(shù)中CO_2氣腹前后患者呼吸、循環(huán)及血氣指標(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;;氣腹時恒定潮氣量通氣對手術(shù)患者呼吸動態(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;;不同氣腹壓力對腹腔鏡膽囊切除術(shù)凝血-纖溶指標(biāo)的影響[J];臨床和實驗醫(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 周漢新,郭躍華,余小舫,鮑世韻,劉嘉林,張悅,任永功,鄭群;Zeus手術(shù)機器人膽囊切除術(shù)與常規(guī)腹腔鏡膽囊切除術(shù)的對比研究[J];中華普通外科雜志;2005年06期

，

本文編號：2139400