腹腔镜阑尾切除术中阑尾根部及系膜不同处理方式的比较

张昕; 李毅; 柏立山; 庄严; 李世邦

doi:10.13898/j.cnki.issn.1000-2200.2019.04.017

腹腔镜阑尾切除术中阑尾根部及系膜不同处理方式的比较

Effect comparison of different treatment methods of the appendix root and mesentery in laparoscopic appendectomy

摘要

摘要:
目的探讨腹腔镜阑尾切除术（LA）中阑尾根部及系膜应用不同处理方法的效果。
方法将2017年1月至2018年3月行LA的171例阑尾炎病人随机分成A、B、C 3组，A组阑尾残端及系膜使用Hemolock夹夹闭；B组采用丝线分别双重结扎阑尾残端及系膜；C组阑尾系膜丝线结扎，阑尾残端结扎后“8”字缝扎包埋残端。评估3组病人手术情况（手术操作时间、术中出血量、术后排气时间）、围手术期并发症（切口感染、腹腔残余脓肿、术后早期炎性肠梗阻）。
结果手术时间A组最短，C组最长（P < 0.01）；术中出血量B组和C组均明显高于A组（P < 0.01），B组和C组差异无统计学意义（P>0.05）；3组术后排气时间、围手术期并发症比较差异均无统计学意义（P>0.05）。
结论3种腹腔镜下阑尾根部及系膜处理方式都是安全可靠的，Hemolock夹夹闭的方式能够缩短手术时间且更适合初学者使用，丝线结扎及缝合包埋残端的方式更适合有一定腹腔镜基础的手术者使用。

Abstract:
ObjectiveTo compare the effects of different treatment methods of the appendix root and mesentery in laparoscopic appendectomy(LA).
MethodsOne hundred seventy-one patients with appendictitis from January 2017 to March 2018 were randomly divided into groups A, B and C.The appendix root and mesentery in group A, group B and group C were treated with using Hemolok-clip clip, silk thread double ligating, and silk thread ligating mesentery combined with "8" suture after embedding the appendix root, respectively.The operation condition(including operation time, intraoperative blood loss and postoperative exhaust time), perioperative complications(including incision infection, abdominal residual abscess and early postoperative inflammatory intestinal obstruction) in three groups were evaluated.
ResultsThe operation time in group A and group C was the shortest and longest, respectively(P < 0.01).The intraoperative blood loss in group B and group C was higher than that in group A(P < 0.01), and the difference of which between group B and group C was not statistically significant(P>0.05).The differences of postoperative exhaust time and perioperative complications among three groups were not statistically significant(P>0.05).
ConclusionsThree methods in dealing with the appendix root and mesentery are safe and reliable in LA.Hemolok-clip can shorten the operation time, and is more suitable for beginner, silk suture combined with embedding the stump after ligation is more suitable for operator with a certain basis of laparoscopic surgery.

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