鄭雅文韓志平Ya-Wen ChengChih-Ping Han姚忠瑾Chung-Chin醫學研究所2026-10-289999-12-312009https://handle.ncl.edu.tw/11296/bc2ku8https://scholars.csmu.edu.tw/handle/123456789/35327近20年腹腔鏡手術來發展日新月異，這種結合科技與技巧的手術，對外科醫師，著實是一大挑戰。本研究主要研究腹腔鏡闌尾切除手術及腹腔鏡超音波在臨床運用的結果。急性闌尾炎是外科醫師最常施行的手術之一，腹腔鏡闌尾切除手術也被引用到治療急性闌尾炎的病患身上。諸多文獻顯示其可行性，同時在與傳統闌尾切除手術比較時，有傷口小、恢復快及併發症較低的優點。然而對穿孔性急性闌尾炎是否腹腔鏡闌尾切除手術治療會有比較好的結果，文獻的報告則有不同的結論。在經驗175例腹腔鏡闌尾切除手術過程，本研究將手術做了些改良，使得併發症減少許多。而後回溯328例腹腔鏡闌尾切除手術病患，將34例經病理報告証實為穿孔性急性闌尾炎的病患做一分析研究，總轉開腹率(total conversion rate)為9%(3/34)，均發生在合併膿瘍形成時，轉開腹(conversion rate)在有膿瘍形成時為33%(3/9)，沒有併發症產生。本研究發現腹腔鏡闌尾切除手術在穿孔性急性闌尾炎操作是可行的。 另外，腹腔鏡超音波則是近年研發出來的診斷工具，本研究在115例腹腔鏡膽囊切除手術的病患中有112例可以成功掃描到整個膽道系統。在配合臨床的分組( Cotton Criteria)，預測總膽管結石在台灣人的發生率時，在低發生率組仍有7% 被發現有總膽管結石，中發生率及高發生率的機會分別為36.4%及78.9%。相信這些數據對臨床醫師會有很大助益。After obtaining a wide experience of laparoscopic appendectomy, we conducted retrospective analysis to assess the feasibility of laparoscopic appendectomy in cases of ruptured appendicitis. During the study period, a total of 328 laparoscopic appendectomies were performed. There were 34 cases of pathology-proven ruptured appendicitis. Patients were divided into three groups according to the operative findings; group 1 (10 cases) consisted of patients with a perforated appendix with local peritonitis, group 2 (15 cases) consisted of those with a perforated appendix with diffuse peritonitis; and group 3 (9 cases) included with an abscess formation around the perforated appendix. Three cases were converted to laparotomy in group 3 .There were no complications and no re-admissions. Our results indicate the laparoscopic approach is feasible for ruptured appendicitis with local or diffuse peritonitis and in selected cases with abscess formation. Also we conducted a study to evaluate the feasibility of LUS during LC, and the occurrence rate of common bile duct (CBD) stones during LC. One hundred fifteen consecutive patients with gall stones were enrolled into this study. LUS was used to assess the common bile duct (CBD) routinely during LC, which was successfully performed in 112 cases. Choledocholithiasis was rated before LC as being of of low, intermediate, or high probability based on clinical, laboratory, and/or imaging findings (Cotton criteria). The CBD could be evaluated in 112 of 115 LC (97.4%) patients (72 female and 40 male). The mean age was 54±16 years old. The occurrence rate of CBD stones in the low risk group was 7%, that in the intermediate group was 36.4%, and the high risk group was 78.9%. The overall incidence of CBD stones was 25.0%. With increasing experience, LUS can become the routine method for evaluating the bile duct during LC. A more aggressive pre-operative evaluation of CBD is mandated in the intermediate and high-risk groups of patients suspected of having CBD stones.thesis