电视腹腔镜行腹股沟斜疝及阑尾手术的尝试

本文报告电视腹腔镜下行腹股沟斜疝内环口缝扎2例、阑尾切除1例、手术经过顺利、术后疼痛轻、恢复快。文中讨论了适应症,手术技术以及作者的初步体会。     

急性阑尾炎临床诊断研究

笔者12年(1974.10—1986.9)来将阑尾炎病人随机分两组进行了对照研究。第一组按症状体征顺序出现诊断阑尾炎142例,误诊1例,误诊率0.7％;第二组用常规方法诊断100例,误诊8例,误诊率8％。两组相比,有非常显著意义(P<0.01)。此结果表明,阑尾炎的症状发生顺序非常有助于阑尾炎的诊断;反之则须仔细检查以免误诊。阑尾炎的症状发生顺序为先腹痛,而后恶心或/和呕吐,最后右下腹痛或/和压痛。体温和白细胞的改变对阑尾炎的诊断缺乏意义。     

Laparoscopic appendectomy in pregnancy

Summary Since 1982 we have operated on more than 150 patients using the laparoscopic appendectomy technique. Our complication rate was 0.75% and the patients included six pregnant women in all stages of pregnancy. There were no complications in this group of six women.Based on a presentation to the XII World Congress of Gynecology and Obstetrics, Rio de Janeiro 1988     

It is not what you do, it is the way that you do it: impact of a care pathway for appendicitis

Background/Purpose

Appendicitis is the most common surgical emergency in children. However, management varies widely. The aim of this study was to assess the impact of introducing a care pathway on the management of childhood appendicitis.

Methods

Data were collected prospectively for 3 successive cohorts:

Group A, before introduction of pathway;

Group B, after introduction of pathway;

Group C, after modification of pathway.

All patients operated for suspected appendicitis were included. The pathway was modified after interim analysis of group B data. P < .05 was significant.

Results

Six hundred patients were included. When compared with group A, group C patients were more likely to receive preoperative antibiotics (P < .0001), undergo formal pain assessment (P < .0001), and be operated before midnight (P = .025). There was a significant decrease in readmission rates from 10.0% to 4.2% (P = .023) despite an increase in cases of gangrenous and perforated appendicitis (P = .010).

Conclusions

The introduction of a care pathway resulted in improved compliance with antibiotic regimens, more frequent pain assessment, and fewer post-midnight operations. Postappendicectomy readmission rates were reduced despite an increase in disease severity. This was achieved by critical reevaluation of outcomes and pathway redesign where appropriate.     

Recurrent abdominal pain due to buckshots in the appendix

Ingestion of foreign bodies is a common paediatric problem, with more than 100,000 cases occurring each year. The majority of these objects are radiopaque. This paper reports a case of elective appendectomy in a patient with unknown ingestion of buckshots affected by recurrent abdominal pain. Plain abdominal films and ultrasound scans showed that the foreign bodies were located in the right lower abdominal quadrant, more specifically in the appendix. CONCLUSION: Foreign bodies in the appendiceal lumen may cause inflammation, perforation and peritonitis. Surgery seems to be the only effective therapeutic approach to foreign bodies in the appendix.     

Acute appendicitis in a patient with hemolytic uremic syndrome: an unusual clinical scenario

Gastroenteritis due to Escherichia coli O157:H7 occurs in young children and is associated with consumption of under cooked beef. Approximately 5–10% of patients will develop hemolytic uremic syndrome (HUS): renal failure, microangiopathic hemolytic anemia, and thrombocytopenia. A 6-year-old boy was admitted with abdominal pain, guaiac positive stool, decreased urine output and elevated creatinine levels. Hemodialysis was initiated upon rapid progression to anuria. On hospital day # 5 he developed acute abdominal pain, which was different from his initial assessment. Exam revealed focal tenderness in the right lower quadrant with localized guarding and rebound. Ultrasound demonstrated a dilated, fluid filled tubular structure in the RLQ concerning for appendicitis. Based on these findings the patient was taken to the operating room for a laparoscopic appendectomy. The patient had undergone dialysis the previous day and was preoperatively treated with DDAVP to minimize the risk of bleeding. The procedure occurred without complication and final pathology confirmed acute appendicitis. This case highlights the unique clinical scenario in which patients with HUS require operative intervention. Surgical procedures can be performed on these patients, however, all precautions should be taken to minimize the risk of bleeding, including the use of preoperative DDAVP.     

Appendiceal endometriosis: two case reports

The incidence of appendiceal endometriosis is lower than 1% among pathologies of pelvic endometriosis. They may occur with findings such as acute appendicitis, invagination, colic or melena, though they are mostly seen with an asymptomatic character. Diagnosis can be made only after a histopathological examination following the operation. We present here two appendiceal endometriosis cases, which were operated on for a prediagnosis of acute appendicitis, but postoperatively diagnosed as appendiceal endometriosis.     

Timing of intervention does not affect outcome in acute appendicitis in a large community practice

BACKGROUND: Surgical management of acute appendicitis remains one of the most frequent problems faced by gastrointestinal surgeons. Traditional management has emphasized urgent surgical care. Recent literature suggests delayed surgery for acute appendicitis does not affect outcome. The outcomes of patients undergoing urgent and delayed appendectomy in a large community surgical practice are compared. METHODS: All patients undergoing appendectomy between August 2002 and May 2007 were reviewed retrospectively. The data were gathered from a large community surgical practice. Patient demographics, treatment times, and surgical, pathologic, and postsurgical outcomes were documented. RESULTS: A total of 1,198 patients underwent appendectomy (575 female/623 male). The mean time to surgical intervention was 7.1 hours (range, 1-24 h). The percentage of patients undergoing laparoscopy versus open versus surgical conversion was 63%, 33%, and 4%, respectively. The percentage of patients with acute appendicitis versus perforated acute appendicitis versus negative exploration was 77%, 14%, and 8.5%, respectively. Postoperative wound or intra-abdominal septic complications were observed in 5.3% and 2.6% of patients, respectively. There was no correlation between the duration of symptoms or time to surgical intervention and surgical approach, pathologic outcome, length of stay, or postoperative septic complications. CONCLUSIONS: Outcome variables documented in this study were independent of duration of symptoms or time to surgical intervention. This would suggest that short delays in surgical intervention for acute appendicitis are well tolerated. Outcome is related more clearly to the severity of the acute appendicitis at presentation.     

Pneumatosis intestinalis after laparoscopic appendectomy: case report and review of the literature

Pneumatosis intestinalis (PI) is the presence of intraluminal gas within the wall of the intestine. As a marker for bowel injury owing to mucosal injury, PI may herald a severe underlying disease process in patients without a significant medical history. In other cases, PI is a benign process, and expectant management is appropriate. Here, we present the first reported case of pneumatosis associated with postoperative abscess after appendectomy and its successful management. Then, we describe the pathophysiology of pneumatosis and review the literature regarding its origin and management.