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1、腹腔镜阑尾切除术系膜固定在困难阑尾切除术中体会【摘要】目的深讨腹腔镜阑尾切除术系膜固定在困难腹腔镜阑尾切除术中的方法及临床意义。方法回顾分析峨眉半导体材料厂、所职工医院2005年5月至2009年8月共开展困难腹腔镜阑尾切除术60例,阑尾周围炎性包块形成26例,阑尾根部坏疽穿孔10例,弥漫性腹膜炎5例,盲肠后位阑尾15例,小阑尾2例,异位肝下阑尾2例。均采用以辅助操作孔为中心,上或下、左或右以不影响辅助操作孔操作为准,相应腹壁体表投影点刺入带有7号丝线的三角针穿过阑尾尖部或根部无血管区的系膜从腹壁引出,用于阑尾悬吊固定或适当移动。结果60例患者均在腹腔镜下完成阑尾切除术,无1例中转开腹,
2、无出血、阑尾残端漏、肠管损伤严重并发症发生。手术时间30～120min,平均75min。术后平均住院4.6d。结论腹腔镜阑尾切除术系膜固定,在困难腹腔镜阑尾切除术中增加手术野暴露、降低镜下精细操作难度,操作简便可行,可有效降低并发症的发生。有利于腹腔镜技术在基层医院推广应用。【关键词】腹腔镜;阑尾切除术;困难;并发症Laparoscopicappendectomyinmesangialfixedinadifficultappendectomysurgeryexperience10TANGShui-ping,LITao,LIUYong,etal.Worker’sHospitalofEme
3、iSemiconductorMaterialFactory&Institute,Sichuan,Emei614200China.【Abstract】ObjectiveDeepdiscusslaparoscopicappendectomymesangialfixedinadifficultappendectomyinthemethodsandclinicalsignificance.MethodsRetrospectiveanalysisofourhospitalfromMay2005toAugust2009weredifficulttocarryout60casesoflaparosc
4、opicappendectomy,Appendicealinflammatorymasssurroundingtheformationof26cases,10casesofappendicealperforationoftherootsofgangrene,diffuseperitonitisin5cases,Smallappendix2casesofectopicliverfollowingappendixin2cases.Holesareusedtocomplementtheoperationofthecenter,orbottom,leftorrightwithoutaffect
5、ingtheoperationofauxiliaryoperationsholesubject,thecorrespondingpointofpiercingtheabdominalwallsurfaceprojectionofthetrianglewitha7-pinthroughthesilkdepartmentorroottipappendectomyavascularzoneofmesangialleadsfromtheabdominalwall,fora10fixedorappropriateappendixhangingmobile.Results60examplepati
6、entscompletetheappendectomyundertheperitoneoscope,doesnothaveanexamplerelaytooperatetheabdomen,doesnothavethehemorrhage,theappendixremnantendleakage,theintestinesdamageseriouscomplicationoccurrence.Surgerytime30~120min,average75min.Afterthetechnique,ishospitalizedequally4.6d.ConclusionTheperiton
7、eoscopeappendectomyisthemembraneisfixed,increasesthesurgeryinthedifficultappendectomytoreveal,toreduceunderwildlythemirrorthefineoperationdifficulty,theoperationsimplefeasible,butreducesthecomplicationeffectivelytheformation
