目的 探讨适于基层医院开展的改良腹腔镜阑尾切除术(laparoscopic appendectomy,LA)的应用技术. 方法 2009年12月～2012年1月采用适宜的麻醉方式、规范化三孔法操作、阑尾系膜单极电凝、自制简易圈套器结扎阑尾根部、自制标本袋阑尾取出等改良的LA技术操作,行LA 390例. 结果 390例均成功完成LA,无一例中转开腹.手术时间15～120 min,平均30 min.术后病理:急性单纯性阑尾炎102例,急性化脓性阑尾炎199例,慢性阑尾炎58例,穿孔坏疽性阑尾炎25例,阑尾周围脓肿6例.异位阑尾16例:肝下2例,盲肠壁内3例,腹膜后位8例,盆腔低位3例；微型短小阑尾1例.390例术后随访2～24个月,平均6个月,无出血、肠瘘、肠粘连梗阻等并发症. 结论 改良的LA适于基层医院开展.%Methods From December 2009 to January 2012, we performed modified LA on totally 390 patients. With appropriate anesthesia, standardized three-port laparoscopy and monopolar coagulation of the mesoappendix was made, and then with the appendix been ligated at the root with a self-made snare, we removed the appendix. Results The procedure was completed in all the patients without conversion to open surgery. The operation time was 30 in average ( 15 - 120 min). Postoperative pathological examination showed acute simple appendicitis in 102 of the patients, acute suppurative appendicitis in 199, chronic appendicitis in 5$, perforated gangrenous appendicitis in 23, and periappendiceal abscess in 6. Ectopic appendix was revealed in 16 cases, among which the appendix was found in subhepatic area in 2, within the cecal wall in 3, in the retroperitoneal space in 8, and the lower pelvis in 3 , the rest one patient had mini appendix. The patients were followed up for 2 to 24 months with a mean of 6 months, during which no hemorrhage, intestinal fistula or intestinal adhesive obstruction occurred. Conclusion Modified LA is applicable in primary hospital.
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