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腹腔镜I期切除不同大小阑尾脓肿的临床评价 预览

Clinical evaluation of laparoscopic operation in treatment of different volumes of periappendiceal abscess
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摘要 目的探讨应用腹腔镜I期切除阑尾脓肿的临床效果。方法收集广州医科大学附属第五医院2010年4月至2016年3月收治可纳入研究的阑尾脓肿患者83例,均首选腹腔镜I期切除阑尾脓肿,术前CT测量阑尾脓肿最大直径,分为A、B、C组,A组阑尾脓肿直径≤5cm,B组5-7cm,C组≥7em。对比分析应用腹腔镜I期切除阑尾脓肿的临床疗效。结果A组手术时间最短f(57.63±14.51)min],术中出血量少[(7.64±3.12)m1],无中转开腹,术后24h内下床活动早(82.4%),肛门排气时间早【(1.62±0.52)d],切口感染率小(5.9%),切口I期愈合率高[32例(94.1%)】,医疗花费少,与B组及C组比较,差异均有统计学意义(P〈0.05);C组手术时间最长[(81.73±13.15)min】,术中出血量[(19.21±3.73)ml】及中转开腹率(33.3%)明显增加,术后下床活动时间延长,切口感染率较高(33.3%),7d内切口非I期愈合率增加,医疗花费明显升高;但3组患者在术后48h内应用镇痛药的比例及其他术后并发症发生率比较,差异无统计学意义(P〉0.05)。结论腹腔镜I期切除直径〈5cm的阑尾脓肿具有安全有效、愈合快、经济实用等优点,适合在临床普遍推广;临床选择腹腔镜I期切除阑尾脓肿直径〉7cm的患者时需慎重。 Objective To explore the clinical effect of laparoscopic clearance for peripheral abscess of appendix. Methods 83 patients with periappendicural abscess undergoing laparoscopic clearance in recent 6 years at our hospital were collected and were divided into three groups according to the diameter measured by CT: the diameter of group A was less than 5 cm, that of group C more than 7 cm, and that of group B 5-7 cm. The clinical effects oflaparoscopic treatment for peripheral abscess of appendix with different sizes were analyzed and compared. Results The operation time was shortest [ ( 57.63±14.51 ) min], the intra-operative bleeding volume was lowest [ ( 7.64± 3.12 ) ml], no one took open surgery, the patients earliest took off-bed activity 24 h after operation, the anal exhaust time were shortest [ ( 1.62 ± 0.52 ) d], the incision infection rate was lowest ( 5.9% ), the primary healing rate was highest ( 94.1% ) , and the medical cost was lowest in group A. The operation time was longest [ ( 81.73±13.15 ) rain], 33.3% patients were transferred for open surgery, the time for off-bed activity after operation was longest, the incision infection rate was highest (33.3%), the incision non-primary healing rate within 7 d was highest, and the medical cost was highest in group C. There were no statistical differences in antalgic drug using rate and the incidences of other postoperative complications between these 3 groups ( P 〉 0.05 ). Conclusions Laparoscopic operation in the treatment ofperiappendiceal abscess whose diameter is less than 5.0 cm is reliable, mini-invasive and economic, so it is worth being generalized. Choosing Laparoscopic operation for periappendiceal abscess whose diameter is more than 7.0 cm should be cautin, s
作者 周如建 王蕊 刘纪明 李伟朋 叶小勇 张帆 吕会增 Zhou Rujian, Wang Rui, Liu Jiming, Li Weipeng, Ye Xiaoyong, Zhang fan, Lyu Huizeng (Department of General Surgery, Fifth Hospital, Guangzhou Medical University, Guangzhou 510700, China)
出处 《国际医药卫生导报》 2016年第24期3728-3730,共3页 International Medicine & Health Guidance News
基金 广东省医学科学技术研究基金(A2010283) 广州市医药卫生科技项目(2014A010081)
关键词 阑尾炎 脓肿 腹腔镜 Appendicitis Periappendicural abscess Laparoscope
作者简介 通信作者:吕会增,E-mail:lvhuizeng@163.COm
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