Appendectomy

Introduction
闌尾炎是指闌尾(俗稱盲腸)因糞便嵌塞或其他原因而發炎。闌尾炎發作迅速,通常出現腹痛及不適等徵狀。幾小時後,腹痛加劇並轉移至右下腹部位,並伴有噁心、嘔吐及發燒等情況。無論男女,任何年齡均可出現闌尾炎。發炎的闌尾應以手術切除,否則它會因破裂而演變為致命的腹膜炎。

其他需要進行闌尾切除術的情況包括進行其他手術程序時偶然切除,或出現闌尾腫瘤。

Surgical procedure

  1. The surgery requires a general anaesthetic.
  2. 程序可以用開放性闌尾切除術或腹腔鏡闌尾切除術進行

開放性闌尾切除術
˙ 在右下腹或中下腹部位開一切口

腹腔鏡闌尾切除術
˙ 在腹部分別開一至三個小切口,以置入儀器

  1. 進入腹膜腔檢查內部情況,並確定病原
  2. 結紮闌尾截停其血液供應,並切除闌尾
  3. If necessary, drain the accumulated fluid with abdominal drainage.
  4. Suturing a wound

Surgical risk
麻醉涉及的併發症(非常罕見,出現機率低於 0.01%,但可導致永久損傷甚至死亡):

  1. Cardiovascular complications: myocardial infarction or ischaemic heart disease, stroke, deep vein thrombosis, pulmonary embolism, etc.
  2. Respiratory tract complications: atelectasis, pneumonia, asthma attack, chronic bronchitis
  3. Allergic reactions and shock
  4. 手術程序涉及的併發症:
  5. 傷口感染及裂開(5 – 30%)
  6. 盆腔積液或膿腫
  7. 糞瘻
  8. 附近其他器官受損,例如膀胱、結腸(~ 5%)
  9. 結紮位置出現滲漏(1%)
  10. Adhesive intestinal obstruction
  11. Death (0.1 – 1%)

Pre-operative preparation

  1. 一旦確診,通常會列為緊急手術進行
  2. Fasting 6 to 8 hours before surgery
  3. 可能需要剃掉陰毛
  4. Change into hospital scrubs before entering the operating room.
  5. 進行手術前先排清尿液
  6. Pre-medication and intravenous infusion may be required.
  7. 建議預先服用抗生素
  8. Inform your doctor about any drug sensitivities, regular medications, or other medical conditions you have.

Post-operative care
一般來說,在進行手術後:

  1. 可能需要繼續進行靜脈內滴注直至能夠進食為止
  2. 可能需要再服用更多或者整個療程的抗生素
  3. 可能因為插管而導致喉部輕微不適或疼痛
  4. 可能感到噁心或作嘔,如果情況嚴重請通知護士
  5. 如果增發止痛藥後仍不足以止痛,請通知護士
  6. 手術 6 個小時後即可起床活動
  7. 一般手術後 2 天即可回家

Wound cuisine

  1. 除另有指示外,手術後頭一、兩天應保持敷料完好和乾爽
  2. 從第 2 天起,檢查傷口後或許可以換上較少的敷料
  3. 避免穿著緊身衣物或對傷口/敷料施加壓力
  4. 約一星期可以除去縫線或皮夾(如有)

Food and drink

  1. Initially, you may need to refrain from eating and drinking.
  2. The next day, you can gradually resume eating as per the doctor's instructions.
  3. It is recommended to eat liquid and fibre-rich foods.

Things to note after discharge

  1. 如果傷口部位痛楚加劇或出現紅腫,請聯絡你的醫生或到急症室求診
  2. If necessary, take the painkillers prescribed by your doctor.
  3. 如醫生認為有需要,請完成整個抗生素療程
  4. Gradual return to normal activities (depending on individual circumstances)
  5. Avoid lifting heavy objects for the first 4 weeks.
  6. Avoid excessive bending and stretching of the body for the first 4 weeks.
  7. Please remember to return to the clinic to have your stitches/staples removed on the scheduled date. Please attend your follow-up appointment at the specialist clinic on time.

Notes
本單張只提供有關手術的基本資料,可能發生的風險或併發症不能盡錄。某類病人的風險度亦為不同。如有查詢,請聯絡你的醫生。

 

資料來源:https://www.ekg.org.hk/pilic/public/surgery_pilic/surgery_appendectomy_0151_chi.pdf

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