【摘要】 目的:探讨腹腔镜阑尾切除术(laparoscopic appendectomy,LA)治疗根部穿孔性阑尾炎的可行性,并提出根部穿孔性阑尾炎的临床分型及处理方法。方法:总结2012年9月至2016年3月收治的124例行LA的根部穿孔性阑尾炎患者的临床资料。根据阑尾根部、回盲部能否充分显露及阑尾根部距盲肠壁完整段的长度,将根部穿孔性阑尾炎分为Ⅰ型(Ⅰa型、Ⅰb型、Ⅰc型)、Ⅱ型,其处理方式为:用可吸收结扎夹对系膜缘侧双重夹闭阑尾根部、间断缝合阑尾残端周围5 mm盲肠壁、距阑尾根部10 mm处用腔内切割吻合器闭合并切割阑尾周围盲肠壁组织及中转开腹。结果:124例患者均痊愈出院,包括Ⅰa型73例、Ⅰb型30例、Ⅰc型18例(早期3例中转开腹,后期15例行LA)、Ⅱ型3例。术后病理均证实根部穿孔性阑尾炎。放置腹腔乳胶引流管的患者,术后48~72 h行腹腔B超检查证实无积液后拔除。随访3~48个月,无粘连性肠梗阻、腹腔脓肿及阑尾残端漏发生。结论:LA治疗根部穿孔性阑尾炎是可行的,必须依据临床分型进行根部处理,腔内切割吻合器处理根部穿孔性阑尾炎具有一定的临床意义。更多还原

【Abstract】 Objective: To explore the feasibility of laparoscopic appendectomy for root perforated appendicitis and put forward the clinical classification and treatment methods of root perforated appendicitis. Methods: From Sep. 2012 to Mar. 2016,124 patients with root perforated appendicitis were treated with laparoscopic appendectomy,and the clinical data were analyzed. According to whether the root of appendix and the ileocecal region coule be adequately revealed and the intact length of appendix root to cecum,root perforated appendicitis were divided into type Ⅰ( Ⅰa,Ⅰband Ⅰc) and type Ⅱ. They could be directly double-clipped with absorbable clamp or interruptedly sutured 5 mm of the cecal wall around the appendiceal stump or cut with an Endo-GIA on the cecal wall at10 mm around the appendiceal stump or directly converted to laparotomy. Results: All the 124 patients were cured,including 73 cases of Ⅰa,30 cases of Ⅰb,18 cases of Ⅰc( 3 early cases converted to laparotomy,and 15 latter cases underwent laparoscopic appendectomy),and 3 cases of Ⅱ. All cases were pathologically confirmed root perforated appendicitis. The latex drainage tube was removed at 48-72 h after the B-ultrasonic examination which confirmed no effusion in the peritoneum. After follow-up of 3-48 months,no adhesive intestinal obstruction,abdominal residual abscess or leakage of appendix stump occurred. Conclusions: Laparoscopic appendectomy for root perforated appendicitis is feasible. Different clinical classification should choose different way. The Endo-GIA is clinically significant in the processing of root perforated appendicitis.更多还原