急性阑尾炎术前超声定位的临床应用及其价值

目的 探讨急性阑尾炎术前超声定位和体表标记法的临床应用及其价值。方法 选取68例经超声检查已明确显示病变阑尾的患者，在超声观察下用防水色笔描记阑尾在腹壁相应体表投影的整体形态，手术切口3cm限定于阑尾的体表投影处，将超声定位结果与手术病理检查结果相比较。结果 超声诊断急性阑尾炎68例，术前超声对病变阑尾的定位均与手术所见相符，其中阑尾盆位14例，盲肠下位13例，盲肠后位11例，回盲前位14例，回盲后位11例，异位阑尾5例。术前超声定位使阑尾切除手术操作方便，明显缩短了术中寻找阑尾的时间，患者出血少，术后恢复快。结论 术前超声定位为症状典型和非典型急性阑尾炎诊断及外科处理提供了客观的影像依据，有助于手术医师在阑尾切除术中快速找到阑尾顺利完成手术。     

Appendiceal stump closure in children with complicated appendicitis: a prospective analysis of endoloops versus endostaples

Introduction: Laparoscopic appendectomy (LA) can be performed safely and effectively using endoloops (EL) or endostaples (ES). We compared EL and ES for stump closure during LA for complicated appendicitis in children. Methods: All LA for complicated appendicitis performed between July 2005 and August 2009 were assessed prospectively. EL were used in 37 procedures and ES in 31. Apart from choice of technique which was the personal preference of the attending surgeon, all patients were managed according to the same intraoperative and postoperative protocols. Results: There was no significant difference between mean age at operation; gender ratio; mean preoperative and postoperative white blood cell; mean preoperative and postoperative white blood cell C‐reactive protein; histopathology; mean operating time (EL: 71 minutes; ES: 64 minutes); mean hospitalization (EL: 5.3 days; ES: 5.1 days); febrile period (EL: 2.1 days; ES: 1.9 days); white blood cell normalization (EL: 2.6 days; ES: 2.4 days); and intravenous antibiotic usage (EL: 3.8 days; ES: 3.7 days). There were no intraoperative complications or ICU admissions in either group, but two EL cases required conversion to open surgery (P=NS). Incidences of intra‐abdominal abscess (EL: n=1 or 2.7%; ES: n=1 or 3.2%), transient ileus (EL: n=2 or 5.4%; ES: n=2 or 6.4%), small bowel obstruction (EL: n=0; ES: n=0), and wound infection (EL: n=1 or 2.7%; ES: n=1 or 3.2 %) were not significantly different. Rate of rehospitalization for EL was 2.7% (n=1; colitis), and for ES, it was 3.2% (n=1; intra‐abdominal abscess) (P=NS). Mean cost for EL was US$890, and for ES, it was US$1300. Conclusion: This is the first prospective study comparing EL and ES during LA for complicated appendicitis in children. ES is more expensive, but there was no significant difference in morbidity for this technique, particularly with regard to incidence of postoperative intra‐abdominal abscess.     

超声检查对小儿阑尾炎诊断及分型的价值

目的:探讨小儿阑尾炎的超声声像图特征及其在诊断和分型中的价值。方法:对临床疑似的174例阑尾炎患儿行超声检查,并将检查结果与手术病理结果相对照。结果:174例中167例超声确诊阑尾炎,5例可疑阑尾炎,与手术病理对照诊断符合率99.4%,且分型总体符合率达93.6%。结论:超声检查对小儿阑尾炎的诊断及临床分型具有重要的指导价值。     

帕瑞昔布钠给药时机对腹腔镜下急性化脓性阑尾炎切除术患者术后炎性因子的影响

【】目的 探讨帕瑞昔布钠给药时机对腹腔镜下急性化脓性阑尾炎切除术患者术后炎性因子的影响,预防及减轻急性化脓性阑尾炎手术围术期应激反应方法选择提供参考。方法 选取2014年6月～2015年6月我院收治的急性化脓性阑尾炎患者100例,随机分为A组与B组,每组各50例,两组患者在入院后均急诊手术,芬太尼、依托咪酯、咪达唑仑及维库溴铵进行麻醉诱导,丙泊酚、瑞芬太尼麻醉维持,A组患者在麻醉诱导前静脉注射帕瑞昔布钠,B组患者在术毕时静脉注射帕瑞昔布钠。观察指标围术期相关指标变化。结果 两组患者丙泊酚用量、手术时间、出血量、阿托品及麻黄碱使用率比较差异无统计学意义,A组术中瑞芬太尼用量为(987±145)μg少于B组(1139±113)μg(P<0.05);IL-6、IL-8、IL-10及TNF-α水平,A组术前分别为(7.84±2.80)ng/L、(8.12±2.97)ng/L、(47.11±12.93)pg/L、(0.97±0.30)mg/L,术后24h分别为(24.11±10.73)ng/L、(20.95±14.61)ng/L、(113.26±23.85)pg/L、(1.45±0.39)mg/L,B组术前分别为(7.91±2.45)ng/L、(8.04±3.05)ng/L、(44.72±13.65)pg/L、(0.99±0.37)mg/L,术后24h分别为(32.73±13.64)ng/L、(33.47±23.74)ng/L、(95.60±21.39)pg/L、(1.94±0.86)mg/L,两组术后24h时以上指标水平较术前升高(P<0.05),术后24h时IL-6、IL-8及TNF-α水平低于B组(P<0.05),IL-10水平高于B组(P<0.05);两组术后24h时VAS评分及24h内自控镇痛泵按压次数比较差异无统计学意义。结论 腹腔镜下急性化脓性阑尾炎切除术患者帕瑞昔布钠在麻醉诱导前给药较术毕给药可减少瑞芬太尼术中用量,更有利于降低术后炎性因子水平,提高抑炎因子浓度,用药时机对术后镇痛无影响。     

根部穿孔性阑尾炎的腹腔镜治疗策略

目的:探讨腹腔镜阑尾切除术(laparoscopic appendectomy,LA)治疗根部穿孔性阑尾炎的可行性,并提出根部穿孔性阑尾炎的临床分型及处理方法。方法:总结2012年9月至2016年3月收治的124例行LA的根部穿孔性阑尾炎患者的临床资料。根据阑尾根部、回盲部能否充分显露及阑尾根部距盲肠壁完整段的长度,将根部穿孔性阑尾炎分为Ⅰ型(Ⅰa型、Ⅰb型、Ⅰc型)、Ⅱ型,其处理方式为:用可吸收结扎夹对系膜缘侧双重夹闭阑尾根部、间断缝合阑尾残端周围5 mm盲肠壁、距阑尾根部10 mm处用腔内切割吻合器闭合并切割阑尾周围盲肠壁组织及中转开腹。结果:124例患者均痊愈出院,包括Ⅰa型73例、Ⅰb型30例、Ⅰc型18例(早期3例中转开腹,后期15例行LA)、Ⅱ型3例。术后病理均证实根部穿孔性阑尾炎。放置腹腔乳胶引流管的患者,术后48~72 h行腹腔B超检查证实无积液后拔除。随访3~48个月,无粘连性肠梗阻、腹腔脓肿及阑尾残端漏发生。结论:LA治疗根部穿孔性阑尾炎是可行的,必须依据临床分型进行根部处理,腔内切割吻合器处理根部穿孔性阑尾炎具有一定的临床意义。     

Laparoscopic Extracorporeal Appendectomy in Overweight and Obese Children

Methods:This single-center retrospective chart review included patients 21 years of age and younger with a preoperative diagnosis of appendicitis who underwent laparoscopic appendectomy from January 2010 through December 2015. Cases of gangrenous and perforated appendicitis were excluded. Subgroup analyses of patients with acute appendicitis were performed. Operative time (OT), length of stay (LOS), and cost were compared between groups stratified by body mass index (BMI) and operative technique.Results:A total of 625 appendectomies were performed—457 for acute appendicitis. Sixty-eight patients were overweight. The SP technique (n = 30) had shorter OT (median minutes, 41 vs 68; P < .001), lower cost (median , $5741 vs $8530; P < .001), and shorter LOS (median hours, 16 vs 19; P = .045) than the TP technique had (n = 38). Seventy patients were obese: 19 were treated with SP and 51 with TP. LOS did not differ significantly between the SP and TP groups, but subjects treated with SP had shorter OT (median minutes, 39 vs 63; P < .001) and lower cost (median, $6401 vs $8205; P = .043).Conclusions:The SP technique for acute appendicitis was found to have a significantly shorter OT and lower cost in all weight groups. There were minimal differences in LOS. SP should be considered in patients with acute appendicitis, regardless of their weight.     

三种评分系统联合高频超声在儿童急性阑尾炎诊断中的价值对比研究

目的 比较改良Alvarado 评分、儿童阑尾炎评分（PAS）、阑尾炎炎症反应评分（AIR）系统联合高频超声（HFUS）在儿童急性阑尾炎（AA）诊断中的价值,为临床早期诊断AA 提供参考依据。方法 回顾性分析2019 年1 月至2020 年6 月因疑似AA 于安徽省儿童医院就诊并行腹腔镜探查术的559 例患儿临床资料,根据术后病理结果将其分为AA 组（n=538）和非AA 组（n=21）。分别使用改良Alvarado、PAS、AIR 评分系统对每例患儿评分,绘制受试者工作特征（ROC）曲线,计算各评分系统ROC 曲线下面积（AUC）及最佳诊断界值。最后分析比较各评分系统单独及联合HFUS 诊断儿童AA 的敏感度、特异度及准确度。结果 改良Alvarado、PAS、AIR 评分的AUC 分别为0.884、0.904、0.808,最佳诊断界值分别为7、6、6 分。单独诊断时,PAS 评分的敏感度、准确度（91.1%、90.5%）高于改良Alvarado 评分（83.5%、83.4%）及AIR 评分（82.3%、81.9%）,差异有统计学意义（P＜0.05）,而特异度比较,差异无统计学意义（P＞0.05）。联合诊断时,改良Alvarado、PAS、AIR 评分联合HFUS 的敏感度、准确度（98.3%、97.5%,98.5%、97.7%,98.1%、97.0%）均分别高于改良Alvarado 评分（83.5%、83.4%）、PAS 评分（91.1%、90.5%）、AIR 评分（82.3%、81.9%）,差异有统计学意义（P＜0.05）,而特异度比较,差异均无统计学意义（P＞0.05）。三种联合诊断方法之间的敏感度、特异度及准确度比较,差异均无统计学意义（P＞0.05）。结论 改良Alvarado、PAS、AIR 评分系统对儿童AA 均有一定的诊断价值,而PAS 评分的诊断水平较高;各评分系统联合HFUS 的诊断效能优于单一评分系统,能够提高儿童AA 诊断的敏感度和准确度,值得临床推广使用。     

二维及彩色多普勒超声诊断急性阑尾炎

目的 探讨二维及彩色多普勒超声对急性阑尾炎诊断的方法及临床价值。方法 联合运用高低频探头结合法、加压法、顺逆旋转扫查法及顺逆旋转延伸扫查法，对280例阑尾炎患者行二维及彩色多普勒超声检查，并与手术结果进行对照分析。结果 280例急性阑尾炎患者中超声诊断正确255例(91．1％)。结论 二维及彩色多普勒超声可作为诊断急性阑尾炎的首选影像学方法，多种方法联合运用可提高其诊断率。     

临床不典型阑尾炎的CT诊断

目的 探讨CT扫描对临床不典型阑尾炎的诊断价值。方法 搜集临床症状和体征不典型．经手术和病理证实为阑尾炎者14例，回顾性分析其CT表现。结果 13例具有阑尾炎的CT表现：5例阑尾增粗、壁增厚．其中2例阑尾内见结石．1例结石位于穿孔阑尾周围；盲肠周围炎8例，腰大肌前方脓肿2例，盲肠末端局限性增厚4例，右侧结肠旁沟及盆腔积液3例。另1例表现为右下腹脓肿因而误诊为盆腔炎。结论 临床症状和体征不典型的阑尾炎临床诊断困难，易造成误诊，多数病例根据其CT表现可做出正确诊断。