三种不同方法行阑尾切除的临床对比研究

发布时间：2018-04-19 08:07

本文选题：悬吊式免气腹 + 腹腔镜阑尾切除术　；参考：《苏州大学》2014年硕士论文

【摘要】：【目的】选取免气腹（gasless laparoscopic appendectomy，GLA）、传统腹腔镜阑尾切除术（laparoscopic appendectomy，LA）以及开腹阑尾切除术（open appendectomy，OA）各100例，通过分析其术前准备时间、手术时间、术中出血量、切口长度、术后肠道恢复时间、住院时间、住院费用、术后并发症等的指标差异，评价三种阑尾切除手术方法的优缺点，并探讨免气腹腹腔镜阑尾切除术在临床工作中的可行性。【方法】选取2012年06月-2014年08月在腰硬联合麻醉下悬吊式免气腹腹腔镜阑尾切除术100例，与同期腰硬联合麻醉下传统腹腔镜阑尾切除术及开腹阑尾切除术各100例进行回顾性对比分析，比较三者之间术前准备时间、平均手术时间、术中平均出血量、切口长度、术后肠道功能恢复时间、住院时间、住院费用、术后并发症等指标的差异。【结果】三组入院病人均成功完成手术，腹腔镜手术组无中转开腹，无腹壁、血管、腹腔内脏器损伤，无皮下血肿及出血，无酸中毒、气胸和CO2气体栓塞等并发症发生。术前准备时间：免气腹腹腔镜阑尾切除组6.5±3.4min，较其它二组长，均具有统计学差异（相比传统腹腔镜组3.5±1.6min，P＜0.05；相比开腹组2.5±1.8min，P＜0.05）。术中出血量：免气腹腔镜组为4.0±1.4ml；相比传统腹腔镜组4.3±1.2ml，P0.05，两组之间差异无统计学意义；相比开腹组15.3±1.8ml，P＜0.05，两组之间差异有统计学意义。手术实际操作时间：免气腹腔镜组34.5±7.6min，相比传统腹腔镜组30.3±5.7min，P0.05，两组之间差异无统计学意义；相比开腹手术组42.3±7.3min，P＜0.05，两组之间差异有统计学意义。手术切口长度：免气腹腔镜组2.5±0.9cm，相比传统腹腔镜组2.5±0.5cm，P0.05，两组之间差异无统计学意义；相比开腹手术组5.5±1.4cm，P＜0.05，两组之间差异有统计学意义。平均肠道功能恢复时间：免气腹腔镜组17.1±7.0小时，传统腹腔镜组23.5±1.6小时，P＜0.05，两组之间差异有统计学意义。相比于开腹手术30.2±6.6小时，P＜0.05，两组之间差异有统计学意义。术后切口感染率：免气腹腔镜组3%，相比传统腹腔镜组4%，P0.05，两组之间差异无统计学意义；相比于开腹手术11%，P＜0.05，两组之间差异有统计学意义。术后肩颈痛情况:免气腹腔镜组3.0±1.0例，相比传统腹腔镜组16.0±2.0例，P＜0.05，两组之间差异有统计学意义。；相比于开腹手术2.0±1.0例，P0.05，两组之间差异无统计学意义。术后上腹部疼痛情况：免气腹腔镜组2.0±1.0例，相比传统腔镜组30.0±7.0例，P＜0.05，两组之间差异有统计学意义。；相比于开腹手术12.0±4.0例，P＜0.05，两组之间差异无统计学意义。术后呕吐：免气腹腔镜组20±5.0例，相比传统腹腔镜组50±7.0例，P＜0.05，两组之间差异有统计学意义，相比开腹手术40±5.0例，P＜0.05，两组之间差异有统计学意义. 总住院时间：免气腹腔镜组2.5±0.5天，相比传统腹腔镜组4.0±0.5天，，P＜0.05，两组之间差有无统计学意义；相比于开腹手术7.5±1.5天，P＜0.05，两组之间差异有统计学意义。住院费用：免气腹腔镜组6512.24±512.09元，传统腹腔镜组7004.45±623.43元，，P＜0.05，两组之间差异有统计学意义【结论】 ①悬吊式免气腹装置安装，稍增加了术前准备时间； ②免气腹腹腔镜下手术切口感染率明显低于开腹组； ③免气腹腹腔镜手术无人工气腹相关并发症发生，术后肠道恢复情况均优于传统腹腔镜组和开腹组； ④免气腹腹腔镜手术术后肩颈疼痛及上腹部疼痛发生率低于传统腹腔镜组及开腹组； ⑤免气腹腹腔镜阑尾切除术可以无需全麻，在连续硬膜外麻醉下实施。其所采用技术、器械要求相对简单，能避免气腹的不良反应，又行微创阑尾切除手术，便于在基层临床中推广应用。
[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.

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R656.8

【参考文献】