Objective To investigate the variation of total hospitalization cost for single-diagnosed disease of different types of acute appendicitis in a three-A hospital, so as to provide evidence for the reimbursement amount of social medical insurance. Methods All patients with acute appendicitis who had surgery treatment during January-April 2011 (before implementing the fee system for single-diagnosed disease) and January-April 2012 (after implementing the fee system for single-diagnosed disease) were collected in this study for analysis. According to the types of acute appendicitis, the patients were stratified into the low risk group (simple, suppurative and gangrenous) and the high risk group (perforative, abscess-formed and pregnancy-combined). The correlation between total hospitalization cost and types of acute appendicitis, as well as the changes of total hospitalization cost after implementing the fee system for single-diagnosed disease were analyzed. Results A total of 90 eligible patients were included. The disease types were positively correlated with hospital stays and total hospitalization cost. All three types in the low risk group could control the average total hospitalization cost within RMB 10 000 yuan. The results of sensitivity analysis showed that, before implementing the fee system for single-diagnosed disease, the total hospitalization cost up to RMB 6 000 yuan could be positively correlated with the above risk stratification (r=0.442, P=0.003). After implementing the fee system for single-diagnosed disease from January to April 2012, the constituent ratio of hospital stays, compared with that in the same period of 2011, had no significant difference (P=0.108) between the two groups; but the ratio of hospital stays (less than 5 days) increased from 45% to 64%, and the ratio of hospital stays (greater than or equal to 10 days) decreased from 17% to 4%, indicating a tendency of shortening hospital stays. Also, the constituent ratio of total hospitalization cost had no significant difference (P=0.114) between the two groups; but the ratio of total hospitalization cost (greater than or equal to RMB 9 000 yuan) decreased from 32% to 13%, indicating a tendency of lowering total hospitalization cost. Conclusion The low risk group of acute appendicitis, RMB 6 000 yuan should be rated as the rational reimbursement amount of social medical insurance. The total hospitalization cost for the high risk group is quite various, so the further studies are needed to investigate the feasibility of the fee system for single-diagnosed disease as well as the rating amount of total hospitalization cost. The implementation of the fee system for single-diagnosed disease is helpful to shorten hospital stays and reduce total hospitalization cost.
目的 分析急性阑尾炎及易与之混淆的其他急腹症的CT图像特征，探讨CT检查对急性阑尾炎诊断及鉴别诊断思路的辅助意义。方法 收集2009年6月至2012年6月期间南方医科大学附属小榄医院收治的120例初步诊断为急性阑尾炎患者的CT影像资料，回顾性分析和对比CT征象，研究其与最终诊断之间的内在联系。结果 120例患者中，单纯性阑尾炎15例，化脓性阑尾炎45例，阑尾坏疽、穿孔25例，阑尾脓肿10例；其他急腹症20例；5例未确诊。阑尾炎患者的术前CT征象因阑尾炎种类不同而略有区别，有56例发现粪石；而其他急腹症的CT征象有结肠管壁局限性增厚、肾输尿管高密度影、肾周筋膜增厚、子宫附件区囊性或实性肿物、肠系膜淋巴结肿大、腹水等。结论 CT检查对急性阑尾炎诊断与鉴别诊断思路的形成具有重要的价值。
目的 探讨急性阑尾炎手术后切口感染的相关因素。方法 观察我院2002年5月至2007年5月期间收治的665例急性阑尾炎患者采用术前预防使用抗生素、术中保护切口、术后加强切口管理等处理后切口感染情况，并分析切口感染与阑尾炎的病程、手术时间、切口选择、留置引流和病理类型之间的关系。结果 本组患者中32例发生切口感染，感染率为4.81% (32/665)，急性阑尾炎术后切口感染与性别无关（ P ＞ 0.05），与病程长短、切口选择、手术时间、腹腔留置引流与否以及病理类型均有关（ P ＜ 0.01）。结论 病程长、手术时间久、炎症较重的急性阑尾炎病例切口感染率较高； 做好围手术期的处理，术中尽量保护切口可以降低切口感染率。
截止至2002年6月,有关阑尾炎治疗的临床证据如下:①辅助性抗生素治疗:1项RCT和1项回顾性RCT发现,经阑尾切除术的复杂性和单纯性阑尾炎的成人和儿童,预防性使用抗生素可显著减少伤口感染和腹腔内脓肿.②辅助性抗生素治疗(儿童复杂性阑尾炎):1项系统评价的亚组分析发现,使用抗生素可显著减少伤口感染.③辅助性抗生素治疗(儿童单纯性阑尾炎):1项系统评价的亚组分析发现,使用抗生素不减少伤口感染.1项儿童单纯性阑尾炎的回顾性RCT发现,预防性使用抗生素不能减少伤口感染,但该RCT的样本量太小,不能排除有临床差别.④抗生素治疗和手术:1项成人疑诊阑尾炎的RCT发现,与手术治疗比较,抗生素保守治疗可减少治疗开始后12 h到10 d的疼痛和吗啡的使用.但采取抗生素保守治疗的患者有35%在1年内再次因急性阑尾炎入院,并行阑尾切除术.⑤腹腔镜手术和开腹手术(成人):1项系统评价发现,腹腔镜手术可以减少伤口的感染,减轻手术后第1天的疼痛,减少住院时间以及恢复工作的时间,但增加手术后腹腔内脓肿的发生.⑥腹腔镜手术和开腹手术(儿童):1项系统评价发现,腹腔镜手术可以减少伤口的感染,减少住院时间,但不能减轻手术后第1天的疼痛,不能减少恢复的时间和腹腔内脓肿的发生.⑦开腹手术和不治疗:无RCT证据.⑧开腹阑尾切除术中对残端的内翻处理:1项RCT发现,两次包埋和单纯结扎比较,不能减少伤口的感染、住院时间和腹腔内脓肿的发生.
目的 比较低频与高频探头超声对急性阑尾炎的诊断价值。 方法 对2010年1月－2011年6月120例急性阑尾炎的手术病理结果与超声检查结果进行回顾性分析，比较低、高频探头超声对急性阑尾炎的诊断价值。 结果 120例急性阑尾炎中，通过低频探头超声检出67例（55.8%），通过高频探头超声检出105例（87.5%）；单纯性阑尾炎以及化脓性和坏疽性阑尾炎高频探头超声检出例数明显大于低频探头超声，差异有统计学意义（P＜0.05）；阑尾周围脓肿低、高频探头超声均全部检出。 结论 高频探头超声对急性阑尾炎的检出率高于低频探头超声，但二者各有所长，在临床中联合应用能有效提高急性阑尾炎的超声诊断符合率。
目的:探讨盲部憩室炎的诊断和手术方式的选择。方法:回顾性分析18例盲部憩室炎的临床资料,包块临床表现、腹部体征、辅助检查、手术方式及随访结果。结果:18例均有右下腹疼痛及右下腹压痛。术前诊断困难,仅通过钡灌肠结肠造影和结肠镜确诊各1例,误诊为急性阑尾炎12例、阑尾周围脓肿1例、回盲部肿瘤3例。憩室单发3例,多发性15例,其中2个憩室9例,3个憩室6例。单纯憩室切除9例,回盲部切除2例;右半结肠切除7例。全组患者均获治愈,无严重并发症发生。结论:盲肠憩室炎的临床特征与急性阑尾炎相似,极易误诊为急性阑尾炎等。术中应注意探查,避免遗漏病变。根据憩室具体情况决定手术方式。
目的比较腹腔镜阑尾切除术（LA）与传统开腹阑尾切除术（OA）在治疗老年（60岁）急性阑尾炎患者的临床疗效。方法回顾性分析2008年6月至2009年12月期间我院收治的67例老年急性阑尾炎患者的临床资料，根据接受的不同手术方式分为LA组（n=28）和OA组（n=39），对2组患者术中及术后相关指标进行比较。结果 LA组患者均顺利完成手术，无中转开腹; 术后无切口感染; 1例出现腹腔残余感染，经抗感染治疗后痊愈。OA组患者术后6例发生切口感染，经换药后痊愈; 5例发生腹腔残余感染，经抗感染治疗后痊愈。2组患者均无出血、阑尾残端漏、残株炎、粘连性肠梗阻等并发症发生。LA组患者手术时间与OA组比较差异无统计学意义（Pgt;0.05）。尽管LA组患者综合费用明显多于OA组（Plt;0.05），但术中出血量、术后下床时间、肛门排气时间、止痛剂使用率、切口感染率、腹腔残余感染率以及住院时间均小（少）于OA组（Plt;0.05）。 结论对老年急性阑尾炎患者的治疗，LA明显优于OA，且可作为老年急性阑尾炎患者治疗的首选术式。