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。
ObjectiveTo investigate the efficacy and safety of laparoscopic surgery for overweight/obese patients with acute perforated or gangrenous appendicitis. MethodsFrom January 2007 to December 2014, patients with acute perforated or gangrenous appendicitis underwent laparoscopic (152 cases) or open (60 cases) appendectomy were collected, who were retrospectively classified into overweight/obese group (BMI≥25 kg/m2, n=69) or normal weight group (BMI < 25 kg/m2, n=143). Conversion rate, operation time, hospital stay, readmission, reoperation, and postoperative complications such as incision infection, abdominal abscess, and lung infection were analyzed. Results①The rate of conversion to open surgery had no significant difference between the overweight/obese group and the normal weight group[4.2% (2/48) versus 6.7% (7/104), χ2=0.06, P > 0.05].②The operation time of laparoscopic surgery in the overweight/obese group was significantly shorter than that of the open surgery in the overweight/obese group[(41.6±11.7) min versus (63.1±23.3) min, P < 0.01], which had no significant difference between the laparoscopic surgery in the overweight/obese group and laparoscopic surgery in the normal weight group[(41.6±11.7) min versus (39.6±12.7) min, P > 0.05].③The total complications rate and incision infection rate of the laparoscopic surgery in the overweight/obese group were significantly lower than those of the open surgery in the overweight/obese group[total complications rate:16.7% (8/48) versus 52.4% (11/21), χ2=9.34, P < 0.01; incision infection rate:4.2% (2/48) versus 33.3% (7/21), χ2=8.54, P < 0.01]. Although the total complications rate of all the patients in the overweight/obese group was increased as compared with all the patients in the normal weight group[27.5% (19/69) versus 14.7% (21/143), χ2=5.02, P < 0.01], but which had no significant difference between the laparoscopic surgery in the overweight/obese group and laparoscopic surgery in the normal weight group[16.7% (8/48) versus 12.5% (13/104), χ2=0.45, P > 0.05].④The reoperation rate of all the patients performed laparoscopic surgery was significantly lower than that of all the patients performed open operation[1.3% (2/152) versus 10.0% (6/60), χ2=6.7, P < 0.01].⑤The abdominal abscess rate, lung infection rate, and hospital stay after discharge had no significant differences among all the patients (P > 0.05). ConclusionLaparoscopic appendectomy could be considered a safe technique for overweight/obese patients with acute perforated or gangrenous appendicitis, which could not increase the difficulty of laparoscopic surgery and the perioperative risk.
ObjectiveTo compare the outcomes of laparoscopic appendectomy (LA) and open appendectomy (OA) for the acute appendicitis patients based on our extensive experiences. MethodsThe data of all the acute appendicitis patients who underwent appendectomy from January 2013 to December 2014 in our department were retrospectively reviewed. A total of 201 patients were enrolled and divided into LA group (n=102) and OA group (n=99). The relevant clinical indexes during and after operation of two groups were compared. ResultsThere were no significant difference in age, gender, and underlying disease between LA and OA patients (P > 0.05). And the abdominal cavity infection rate, abdominal drainage rate and 30-day readmission rate were also similar (P > 0.05). But LA group had less operative time, lower infection operative wound rate, less intestinal function recovery time, shorter inhospital days and higher hospital expenses than OA group (P < 0. 05). In addition, perforated appendix and LA could increase the rate of abdominal drainage[OR=2.710, 95% CI(1.129, 6.507), P=0.026]. ConclusionsBoth LA and OA are safe and effective methods for the treatment of acute appendicitis. But LA has several advantages over OA on less operative time and postoperative complications, earlier recovery, and shorter inhospital days. While LA have higher hospital cost than OA, it still should be considered as a prefer way to cure acute appendicitis. LA is a independent risk factor of abdominal drainage.
ObjectiveTo analyze the multidetector computed tomography (MDCT) findings of normal appendices and appendices of acute appendicitis in old patients, and to explore the clinical value of MDCT in assessing acute appendicitis in old patients. MethodsSixty-six cases of acute appendicitis confirmed by surgery in 24 hours after MDCT scan from Jun. to Oct. 2016 (acute appendicitis group), and 40 cases underwent MDCT scan for non-abdominal pain causes without appendiceal lesions from Sep. to Oct. 2016 (normal appendices group), were included, and the MDCT images of both 2 groups were retrospectively analyzed. Observation items included:location, diameter, mural thickness, intra-luminal contents, and changes of surrounding structures. Results① Rate of appendices visualization. In total of 95.5% (63/66) appendices were visualized on MDCT in acute appendicitis group, while 95.0% (38/40) appendices were visualized on MDCT in normal appendices group (P > 0.05). ② Locations of appendices. Acute appendicitis group:appendices were found to be located at pelvic cavity in 22 cases, in front of ileum in 2 cases, behind ileum in 10 cases, below cecum in 25 cases, and behind cecum in 4 cases. Normal appendices group:appendices were found to be located at pelvic cavity in 15 cases, in front of ileum in 3 cases, behind ileum in 7 cases, below cecum in 5 cases, and behind cecum in 8 cases. There was significant difference between 2 groups in terms of location of appendices (P < 0.05). The appendices in acute appendicitis group located mainly at pelvic cavity and below cecum, while the appendices in normal appendices group located mainly at pelvic cavity. ③ The diameter and thickness of appendices. The appendiceal diameter and thickness in acute appendicitis group were (11.4±4.2) mm (6.2-21.9) mm and (4.3±2.2) mm (1.1-8.6) mm, respectively, while those in normal appendices group were (6.1±1.4) mm (3.7-8.6) mm and (1.7±0.8) mm (0.5-3.2) mm, respectively. The diameter and thickness of appendices in acute appendicitis group were significantly greater than those in normal appendices group, respectively (P < 0.05). ④ Contents of appendices. Acute appendices group:there was effusion with air in 14 cases in appendiceal cavity, full of effusion in 36 cases, and appendicolith combined with effusion in 13 cases. Normal appendices group:there was full of air in 15 cases in appendiceal cavity, air with a little faeces of higher density in 13 cases, and nothing in 10 cases. Effusion was more common in appendiceal cavity in acute appendicitis group, while air was more common in normal appendices group. ⑤ Around appendices. Fat stranding was seen in 57 cases, adjacent parietal peritoneum thickening was seen in 56 cases, focal effusion was seen in 18 cases, abscess was seen in 2 cases, free air in peritoneal cavity was seen in 8 cases, and lymphadenopathy was seen in 35 cases. None of these imaging features were seen in normal appendices group. ConclusionsMDCT can demonstrate features of normal appendices and acute appendicitis in old patients. MDCT yield high diagnostic accuracy in acute appendicitis in old patients, and can provide useful information before surgery.
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。
ObjectivesTo assess the predictive value of neutrophils-to-lymphocytes ratio (NLR) in the diagnosis of children complicated appendicitis.MethodsThe clinical data of patients with acute appendicitis treated in Department of Pediatric Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University from January 2014 to June 2017 were analyzed retrospectively. Based on the pathology results, patients were divided into two groups: simple appendicitis and complicated appendicitis. The differences of age, gender, disease time, fever, highest temperature, emesis, right lower abdominal pain, blood indicators, and ultrasound results between the two groups were analyzed. Useful parameters to aid in the diagnosis of children complicated appendicitis were screened through single-factor and multiple-factor analysis. The predictive value of the parameters was evaluated by ROC analysis, sensitivity and specificity.ResultsA total of 235 patients was evaluated and divided into simple appendicitis group (179 patients) and complicated appendicitis group (56 patients). Logistic regression analysis revealed that NLR was the independent risk factor for diagnosis of children complicated appendicitis. When NLR>11.74, the Youden index for predictive complicated appendicitis was the biggest, reaching 0.325, and the sensitivity and specificity were 47.8% and 84.7%, respectively (OR=3.121, 95%CI 2.036 to 4.783).ConclusionsThe preoperative NLR is a certain indicator for predicting children complicated appendicitis, and can be used as reference to whether or not receive an operation.
ObjectiveTo systematically review the effectiveness of appendicectomy versus antibiotics for uncomplicated acute appendicitis (UAA). MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 8, 2016), Web of Science, CBM, WanFang Data and CNKI were searched to collect randomized controlled trials (RCTs) about appendicectomy versus antibiotics for uncomplicated acute appendicitis from inception to September 2016. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 10 RCTs studies involving 2 028 patients were included. The results of meta-analysis showed that, compared with antibiotics, the appendicectomy could shorten duration of hospital stay (MD=–1.89, 95%CI –2.75 to –1.04, P<0.000 01), the therapeutic time of antibiotics (MD=–4.42, 95%CI –5.06 to –3.79, P<0.000 01), improve the efficiency of clinical treatment (OR=23.48, 95%CI 7.99 to 68.96, P<0.000 01), decrease the recurrence rate (OR=0.02, 95%CI 0.01 to 0.05, P<0.000 01), however, there was no significant difference in the incidence of postoperative complications between two groups (OR=1.35, 95%CI 0.31 to 5.87, P=0.69). ConclusionThe current evidence shows that, compared with antibiotics, the appendicectomy for uncomplicated acute appendicitis can shorten duration of hospital stay and the therapeutic time of antibiotics, improve the efficiency of clinical treatment, decrease the recurrence rate. Due to the limited quality of included studies, more high quality studies are needed to verify the above conclusion.