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Further Exploring and Discussing Clinical Value of Laparoscopic Appendectomy

ObjectiveTo further explore and discuss the value of laparoscopic appendectomy. MethodsThe clinical data of 200 patients underwent appendectomy in this hospital from April 2009 to December 2010 were collected. The operation time, postoperative hospital stay, cost of hospitalization, postoperative anal exhaust time, postoperative pain score, and surgical complications were compared between laparoscopic appendectomy and open appendectomy. ResultsThere were 8 cases conversion to the open approach in this series. The cost of laparoscopic appendectomy was higher than that of open appendectomy (Plt;0.05); the cases of chronic appendicitis, acute simple appendicitis, acute suppurative appendicitis within 36 h of onset treated by laparoscopic appendectomy had shorter operation time, shorter postoperative hospital stay, earlier postoperative anal exhaust time, and slighter postoperative pain than those treated by open appendectomy (Plt;0.05); the differences in postoperative hospital stay, postoperative anal exhaust time, postoperative pain of acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis treated by two types of surgery had no statistical significances (Pgt;0.05); the operation time of acute gangrenous appendicitis operated by laparoscopic surgery was longer than that by open appendectomy (Plt;0.05); incision infection rate of laparoscopic appendectomy was lower than that of open appendectomy (Plt;0.05). ConclusionsFor chronic appendicitis, acute simple appendicitis, and acute suppurative appendicitis within 36 h of onset, the outcome and advantages of laparoscopic appendectomy are outstanding, the value of application is clear; and for acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis, laparoscopic appendectomy is difficult and with high rate of conversion, no obvious advantages in recovery after surgery but an increase of medical costs, and the application value is not great.

高频超声与压痛点相结合诊断急性阑尾炎

【摘要】　目的　探讨高频超声与腹部压痛点相结合诊断急性阑尾炎的临床价值。　方法　2008年1月-2009年11月，对临床疑诊为阑尾炎的138例患者进行急诊右下腹超声检查，将超声诊断与手术及病理结果进行对照。　结果　高频超声诊断急性阑尾炎的敏感性72%，特异性96%，阳性预测值96%，阴性预测值76%。　结论　高频超声是诊断急性阑尾炎的方法之一，可协助临床快速诊断急性阑尾炎，为是否手术提供参考依据，对确定切口位置的选择有一定的帮助。

Effect of Povidone Iodine for Preventing The Surgical Site Infections in Class Ⅲ Appendectomy Incision

目的探讨碘伏原液浸泡对于预防阑尾Ⅲ类手术切口手术部位感染（SSI）的疗效。 方法回顾性分析笔者所在医院2012年5月至2013年5月期间施行阑尾切除术者中切口类型为Ⅲ类的92例患者的临床资料，比较以碘伏原液浸泡切口（浸泡组）和冲洗切口（常规组）处理后患者的切口愈合情况。 结果术后常规组57例患者中，有43例切口愈合等级为甲级，5例为乙级，9例为丙级，SSI发生率为24.56%（14/57）。浸泡组35例患者的切口愈合均良好，均为甲级愈合，SSI发生率为0，低于常规组（P<0.05）。 结论采用碘伏原液浸泡切口5 min能有效预防阑尾炎Ⅲ类切口SSI的发生，值得临床推广应用。

妊娠阑尾炎的诊治体会

目的探讨妊娠阑尾炎的诊断与最佳手术时间。 方法回顾性分析2011年10月至2015年10月期间我院诊治的50例妊娠阑尾炎患者的临床资料。根据发病后至手术时间分为观察组和对照组，观察组为发病时间24 h内进行手术者，对照组为发病时间超过24 h进行手术者。比较2组患者的平均住院时间、早产率、切口感染率和术中引流管放置率。 结果2组患者的年龄、孕周、血白细胞计数及体温比较差异均无统计学意义（P＞0.05），观察组急性蜂窝织性阑尾炎患者所占比例明显高于对照组（χ2=9.93，P=0.002），而对照组急性坏疽性阑尾炎患者所占比例明显高于观察组（χ2=9.93，P=0.002）。观察组的住院时间明显短于对照组（t=2.36，P=0.02），早产率、切口感染率及术中引流管放置率均明显低于对照组（χ2=5.56，P=0.018；χ2=5.35，P=0.021；χ2=8.42，P=0.004）。 结论妊娠阑尾炎强调早期诊断和及早手术治疗，发病时间24 h内进行手术治疗效果较好。

乳腺癌广泛腹腔转移误诊急性阑尾炎1例报道

腹腔镜下困难型阑尾切除术的治疗体会（附51例报道）

目的总结腹腔镜下困难型阑尾切除术的手术技巧。 方法回顾性分析我科2011年4月至2015年3月期间腹腔镜下切除的51例困难型阑尾患者的临床资料。 结果51例患者中男28例，女23例。年龄（38.5±12.9）岁。急性腹痛发作时间平均46.5 h。急性化脓性阑尾炎33例，急性坏疽性阑尾炎12例，急性单纯性阑尾炎5例，另有1例疑似Crohn病（二次手术后明确）。手术难点：阑尾显露困难、阑尾根部处理困难、阑尾系膜处理困难。本组患者除1例术中疑似Crohn病经二次手术证实为末段回肠Crohn病外，其余50例切除困难型阑尾患者均在腹腔镜下成功完成手术。手术时间平均65 min，术中出血量平均15 mL，术后下床活动时间平均18 h，住院时间平均6 d。术后1例合并糖尿病患者发生穿刺孔感染，1例患者发生粪漏，1例并发麻痹性肠梗阻，均经保守治疗后痊愈。 结论困难型阑尾在腹腔镜下切除安全、可行，不增加手术并发症，能充分体现微创手术的优势。

Application Value of CT in Preoperative Diagnosis of Omental Torsion

ObjectiveTo summarize the clinical features and imaging features of CT in the omental torsion, and in order to reduce the misdiagnosis and missed diagnosis rate of imaging features. MethodsThe data of 16 cases of omental torsion (secondary 15 cases, primary 1 case) and 286 cases of acute appendicitis (eliminated the subhepatic and retroperitoneal ectopic appendix) in our hospital from 1998 to 2014 were retrospectively analyzed. ResultsEleven cases of omental torsion suffered from the shifting pain in right lower quadrant. No obvious shifting abdominal pain was observed in other 4 cases whose main manifestations were abdominal tenderness and rebound tenderness around umbilicus. The patient of the remaining 1 case had enclosed mass in the area of left groin with pain and suffered from continuous periumbilical pain. Abdominal spiral CT examination was performed in 16 patients before operation. Increased signal intensity of globular soft tissue, which deviating from McBurney's point, was found at level of distal umbilicus by preoperative spiral CT in 13 cases. One case of omental torsion associated with ncarcerated inguinal hernia was missed. ConclusionsOmental torsion manifests chiefly shifting pain in right lower quadrant, abdominal tenderness, and rebound tenderness around umbilicus. It is easily confused with appendicitis. Abdominal spiral CT should be chosen as a preferred means in preoperative diagnosis of omental torsion.

Contrastive Study Between Laparoscopic Appendectomy and Open Appendectomy

目的比较腹腔镜阑尾切除术(LA)与开腹阑尾切除术(OA)治疗急性阑尾炎的疗效和手术安全性。方法回顾性分析2010年7~12月期间的50例LA患者的临床资料，与同期55例施行OA的患者进行比较。结果LA组与OA组在手术时间及术中出血量方面差异均无统计学意义(Pgt;0.05); LA组术后肠功能恢复时间、下床活动时间及住院时间均明显短于OA组(Plt;0.05)，LA组镇痛药使用率及术后并发症发生率明显少于OA组(Plt;0.05); 但住院费用LA 组高于OA组(Plt;0.05)。结论LA在治疗阑尾炎方面有明显优势，值得推广。

妊娠合并急性阑尾炎的临床分析

【摘要】 目的 总结妊娠合并急性阑尾炎的诊断及治疗方法。 方法 回顾性分析1999年2月-2008年6月入院的27例妊娠合并急性阑尾炎患者的临床资料。 结果 3例症状较轻者保守治疗成功；24例行阑尾切除术，流产2例，胎死宫内3例。 结论 妊娠合并急性阑尾炎的临床表现不典型，确诊后应及时手术治疗。

Laparoscopic Appendectomy by Concealed Three Ports Technique (Report of 192 Cases）

目的　 探讨隐蔽三孔法腹腔镜阑尾切除术的应用。方法　患者取头低左侧卧位。在脐缘切口插入10 mm的套管，放入腹腔镜。在腹腔镜监视下分别于耻骨结节左、右侧阴毛生长区作10 mm、5 mm切口，两切口相距8~10 cm。术者通过耻骨上途径完成阑尾切除操作。结果　192例痊愈出院，无一例手术中转，平均手术时间（25±4.32） min，平均住院时间（5±0.79） d。切口甲级愈合，基本不留疤痕。无手术并发症发生。结论　隐蔽三孔法腹腔镜阑尾切除术具有美容效果好、创伤小、并发症少等优点。