免气腹与传统气腹腹腔镜阑尾切除术的临床对比研究
发布时间：2018-07-23 12:20
【摘要】：[目的] 通过对比分析免气腹腹腔镜阑尾切除术(gasless laparoscopic appendectomy, GLA)和传统腹腔镜阑尾切除术(laparoscopic appendectomy, LA)的术中及术后的指标差异,来探讨免气腹腹腔镜阑尾切除术在日常临床工作中的可行性。 [方法] 搜集上海第九人民医院奉城分院普外科2012年06月至2013年12月在腰硬联合麻醉下行悬吊式免气腹腹腔镜阑尾切除术的患者30例,与同期腰硬联合麻醉下传统腹腔镜阑尾切除术患者30例的资料进行对比分析,比较两组平均手术时间、术中平均出血量、术后肠道功能恢复时间、住院时间及术后并发症等指标。 [结果] 两组均成功完成手术,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C02气体栓塞等并发症发生。切口均甲级愈合。比较两组术前术后血液二氧化碳结合率变化(免气腹组没有明显差异(P0.05),气腹组存在差异(P0.05)),两组术中出血量(免气腹组10.0±12.4毫升,气腹组8.3±14.2毫升,P0.05)、手术实际操作时间(免气腹组32.5±7.6分,气腹组30.3±7.7分,P0.05)及住院时间(免气腹组3.1±1.1天,气腹组3.2±0.9天,P0.05)等,两组差异均无统计学意义；比较两组术前准备时间(免气腹组10.5±3.6min,气腹组3.5±1.6min,P0.05).平均肠道功能恢复时间(免气腹组14.1±4.0小时,气腹组18.1±4.5小时,P0.05)及术后并发症(免气腹组腹壁疼痛及肩部疼痛例数明显少于气腹组,但存在一例应用克氏针穿刺牵引皮肤,导致该处皮肤组织血肿形成),两组差异有统计学意义。 [结论] ①免气腹腹腔镜阑尾切除术对机体内环境干扰小,基本不影响酸碱平衡及心肺功能,应用于老年患者及原有心肺疾患的急诊阑尾炎病人的安全性高； ②免气腹手术无人工气腹相关并发症发生,术后肠道恢复情况优于气腹组； ③阑尾手术应用免气腹技术,手术空间基本足够,手术视野清晰； ④目前悬吊式免气腹装置安装繁琐,增加了术前准备时间； ⑤目前悬吊式免气腹技术牵引腹壁的方式是有创的,存在一定风险。
[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 卤14.2 ml), operative time (32.5 卤7.6 points in pneumoperitoneum group, 30.3 卤7.7 minutes in pneumoperitoneum group) and hospitalization time (3.1 卤1.1 days in pneumoperitoneum group and 3.2 卤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 卤3.6 min in pneumoperitoneum group and 3.5 卤1.6 min in pneumoperitoneum group). The average recovery time of intestinal function (14.1 卤4.0 hours in pneumoperitoneum group and 18.1 卤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.
【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
本文编号：2139400
[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 卤14.2 ml), operative time (32.5 卤7.6 points in pneumoperitoneum group, 30.3 卤7.7 minutes in pneumoperitoneum group) and hospitalization time (3.1 卤1.1 days in pneumoperitoneum group and 3.2 卤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 卤3.6 min in pneumoperitoneum group and 3.5 卤1.6 min in pneumoperitoneum group). The average recovery time of intestinal function (14.1 卤4.0 hours in pneumoperitoneum group and 18.1 卤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.
【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
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