【摘要】：目的:通過(guò)比較應(yīng)用經(jīng)臍單孔腹腔鏡(transumbilical laparoendoscopic single-site surgery,TU-LESS)與傳統(tǒng)三孔腹腔鏡(three—port Traditional laparoscopic)在化膿性闌尾炎手術(shù)中的療效,來(lái)探討TU-LESS技術(shù)在治療化膿性闌尾炎伴腹膜炎體征患者時(shí)的適應(yīng)癥及功效。方法:選取2011年09月至2015年03月山西醫(yī)科大學(xué)第一附屬醫(yī)院普通外科收治的化膿性闌尾炎伴穿孔或壞疽等并發(fā)癥且繼發(fā)腹膜炎體征的病例。其中應(yīng)用TU-LESS技術(shù)進(jìn)行腹腔探查后行闌尾切除術(shù)58例為實(shí)驗(yàn)組。另外,對(duì)照組選擇相同的手術(shù)醫(yī)生應(yīng)用三孔腹腔鏡施行闌尾切除術(shù)42例。比較兩組的術(shù)中出血量、術(shù)后在院治療時(shí)間、手術(shù)后腸功能恢復(fù)正常所需時(shí)間,手術(shù)所需時(shí)間、麻醉結(jié)束后疼痛程度等指標(biāo)。結(jié)果:實(shí)驗(yàn)組與對(duì)照組相比,實(shí)驗(yàn)組應(yīng)用TU-LESS技術(shù)完成手術(shù)52例,占實(shí)驗(yàn)組總手術(shù)量的89.65%,術(shù)中增加戳卡改為傳統(tǒng)腹腔鏡術(shù)式4例、術(shù)中改為傳統(tǒng)剖腹闌尾切除術(shù)2例;對(duì)照組應(yīng)用傳統(tǒng)三孔法完成手術(shù)38例,占對(duì)照組總手術(shù)量的90.47%,術(shù)中更改為傳統(tǒng)剖腹闌尾切除術(shù)4例.術(shù)中出血量、術(shù)后在院治療時(shí)間、手術(shù)后腸功能恢復(fù)正常所需時(shí)間,手術(shù)所需時(shí)間均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。傳統(tǒng)腔鏡組麻醉結(jié)束后疼痛感覺(jué)高于實(shí)驗(yàn)組(P0.05)。結(jié)論:在治療伴腹膜炎體征的化膿性闌尾炎時(shí)TU-LESS技術(shù)可以滿足術(shù)中所需的腹腔探查、闌尾切除的要求。經(jīng)臍單孔腹腔鏡闌尾切除術(shù)不僅可應(yīng)用于單純性闌尾炎,而且在伴腹膜炎體征的化膿性闌尾的診斷和治療中也有確切的療效。
[Abstract]:Objective: to compare the efficacy of transumbilical single-hole laparoscopic (transumbilical laparoendoscopic single-site surgery,TU-LESS) and traditional three-hole laparoscopy (three-port Traditional laparoscopic) in suppurative appendicitis. To investigate the indications and efficacy of TU-LESS technique in the treatment of suppurative appendicitis with peritonitis signs. Methods: cases of suppurative appendicitis with complications such as perforation or gangrene and secondary peritonitis signs were selected from the general surgery department of the first affiliated Hospital of Shanxi Medical University from September 2011 to March 2015. Among them, 58 cases were treated with appendectomy after abdominal exploration with TU-LESS technique. In addition, 42 cases of appendectomy were performed by three-hole laparoscopy in the control group. The blood loss during operation, the time of hospitalization after operation, the time required for the recovery of intestinal function after operation, the time required for operation, and the degree of pain after anesthesia were compared between the two groups. Results: compared with the control group, 52 patients in the experimental group were operated by TU-LESS technique, which accounted for 89.65% of the total operating volume in the experimental group, 4 cases were replaced by the traditional laparoscopic operation during the operation, and 2 cases were replaced by the traditional appendectomy during the operation. In the control group, 38 cases (90.47%) were operated by traditional three-hole method, and 4 cases were changed into traditional appendectomy during operation. There was no significant difference in the amount of blood lost during the operation, the time spent in hospital after operation, the time required for the recovery of intestinal function after operation, and the time required for operation (P0.05). The pain in the traditional endoscopic group was higher than that in the experimental group after anesthesia (P0.05). Conclusion: in the treatment of suppurative appendicitis with peritonitis signs, TU-LESS technique can meet the needs of abdominal exploration and appendectomy. Transumbilical laparoscopic appendectomy can not only be used in simple appendicitis, but also in the diagnosis and treatment of suppurative appendicitis with peritonitis signs.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R656.8

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