腹腔镜及开腹手术治疗小儿复杂性阑尾炎268例

目的:对比分析腹腔镜和开腹阑尾切除术在治疗小儿复杂性阑尾炎中的疗效.方法:回顾性分析2000-01/2009-11小儿复杂性阑尾炎患者268例临床资料,其中腹腔镜阑尾切除术(LA)128例,开腹阑尾切除术(OA)140例,比较两组手术情况和疗效.结果:手术时间:LA组较OA组长(62.2 min±15.3 min vs 57.1 min±6.4 min,P<0.01);术后肛门排气时间:LA组较OA组短(26.8 h±7.6 h vs 42.9 h±8.3 h.P<0.001);术后住院时间:LA组较OA组短(5.2 d±2.3 d vs 9.5 d±2.6d,P<0.001);术后腹腔脓肿LA组1例,OA组9例(P=0.036);切口感染:LA组3例,OA组28例(P<0.001);肠梗阻:LA组2例,OA组5例(P=0.518).结论:LA较OA具有创伤小、恢复快、并发症少、住院时间短和美容效果好等优点,是治疗小儿复杂性阑尾炎一种安全有效的手术方式.     

Stump appendicitis and generalized peritonitis due to incomplete appendectomy

Abstract. Stump appendicitis is a rare clinical situation when there is incomplete appendectomy. A wide spectrum of diseases in the differential diagnosis of right lower quadrant pain of the abdomen and presence of appendectomy operation in a patients history delay the diagnosis. We report such a case of perforated stump appendicitis and generalized peritonitis occurring eight months after appendectomy.     

CT is useful for identifying patients with complicated appendicitis

BACKGROUND AND AIMS: We often come across patients with complicated appendicitis (perforation, abscess formation, or peritonitis) and it is essential to get accurate and detailed information on these patients preoperatively. In this study, we investigated whether or not preoperative computed tomography is useful for identifying these patients. PATIENTS AND METHODS: Plain and intravenously-contrasted helical computed tomography was obtained preoperatively in 94 (75%) of 125 patients who underwent appendectomy. Twenty-eight (30%) of the 94 patients had complicated appendicitis (Compli(+) group). We compared clinical factors and computed tomography findings of the Compli(+) group with those of 66 other patients (Compli(-) group). RESULTS: There was no significant difference between the Compli(+) and Compli(-) groups in gender, white blood cell count, the present rate of an enlarged appendix, or appendicolith. Fat stranding and free fluid on computed tomography were significantly associated with complicated appendicitis by both univariate and multilogistic regression analysis. Fourteen (70%) of the 20 patients with fat stranding and free fluid on computed tomography had complicated appendicitis and only 1 (4%) of the 28 Compli(+) patients had neither fat stranding nor free fluid on computed tomography. CONCLUSION: Our study has indicated that fat stranding and free fluid on computed tomography are significant for complicated appendicitis and helical computed tomography is a powerful tool for identifying patients with complicated appendicitis preoperatively.     

慢性阑尾炎腹腔镜手术治疗

目的 探讨腹腔镜下慢性阑尾炎治疗的可行性、方法和效果。方法 选择8例慢性阑尾炎病人行腹腔镜阑尾切除术。结果 8例均成功完成腹腔镜手术。平均手术时间30min，术中几乎不出血。术后胃肠功能平均恢复时间分别1．2d。术后平均进流质时间6h。无一例中转开腹，无一例手术并发症。结论 慢性阑尾炎行腹腔镜手术治疗安全、可行，具有创伤小、术后恢复快等微创手术优势，可获得与开腹手术相同的疗效。     

New strategy during complicated open appendectomy: Convert open operation to laparoscopy

AIM: To introduce a new strategy during complicated open appendectomy - converting open operation to laparoscopy.METHODS: We retrospectively reviewed databases at two institutions between October 2010 and January 2013, identifying 826 patients who had undergone complicated appendectomy for histologically confirmed acute or chronic appendicitis. They included 214 complicated appendectomies: 155 lengthened-incision open appendectomies (LIA group) and 59 open appendectomies with conversion to laparoscopy (OACL group).RESULTS: A total of 214 patients with complicated appendectomies were included in the study, including 155 cases of LIA and 59 cases of OACL. No major complication leading to death occurred in the study. Patient characteristics of the two groups were similar. Several parameters showed a significant difference between the two groups. For the OACL vs LIA groups they were, respectively: incision length (3.8 ± 1.4 cm vs 6.2 ± 3.5 cm, P < 0.05); time to flatus recovery (2.3 ± 0.6 d vs 4.2 ± 0.8 d, P < 0.05), drainage rate (61.0% vs 80.0%, P < 0.05); pain level (3.6 ± 1.8 vs 7.2 ± 2.4, P < 0.05); hospital stay (5.1 ± 2.7 d vs 8.7 ± 3.2 d, P < 0.05); complication rate (8.5% vs 14.7%, P < 0.05). Other factors showed no significant differences.CONCLUSION: Lengthened-incision open appendectomy increases the incidence of complications and prolongs the hospital stay. Conversion of open to laparoscopic appendectomy is feasible and efficient in complicated cases. It decreases the rate of incisional and abdominal infections, allows faster return of bowel movements, and shortens the hospital stay.     

老年急性阑尾炎行腹腔镜与开腹手术的对比分析

目的对比分析腹腔镜(LA)和开腹阑尾切除术(OA)治疗老年急性阑尾炎的手术效果。方法2003年1月至2006年1月行阑尾切除术治疗老年阑尾炎56例,其中LA27例,OA29例。比较2种术式的手术时间、下床活动时间、术后排气时间、疼痛评分、误诊率、止痛药使用率、切口感染率、置管引流率、残余脓肿发生率、住院时间和综合费用。结果LA组和OA组以上各指标(除手术时间和综合费用外)差异均有统计学意义(P<0.05)。结论对于老年急性阑尾炎,和OA相比,LA具有创伤小、恢复快、并发症少和平均住院时间短等优点,值得临床推广。     

Single-incision laparoscopic appendectomy vs conventional laparoscopic appendectomy:Systematic review and meta-analysis

AIM: To assess the differences in clinical benefits and disadvantages of single-incision laparoscopic appendectomy(SILA) and conventional laparoscopic appendectomy(CLA).METHODS: The Cochrane Library,MEDLINE,Embase,Science Citation Index Expanded,and Chinese Biomedical Literature Database were electronically searched up through January 2013 to identify randomized controlled trails(RCTs) comparing SILA with CLA.Data was extracted from eligible studies to evaluate the pooled outcome effects for the total of 1068 patients.The meta-analysis was performed using Review Manager 5.2.0.For dichotomous data and continuous data,the risk ratio(RR) and the mean difference(MD) were calculated,respectively,with 95%CI for both.For continuous outcomes with different measurement scales in different RCTs,the standardized mean difference(SMD) was calculated with 95%CI.Sensitivity and subgroup analyses were performed when necessary.RESULTS: Six RCTs were identified that compared SILA(n = 535) with CLA(n = 533).Five RCTs had a high risk of bias and one RCT had a low risk of bias.SILA was associated with longer operative time(MD = 5.68,95%CI: 3.91-7.46,P < 0.00001),higher conversion rate(RR = 5.14,95%CI: 1.25-21.10,P = 0.03) and better cosmetic satisfaction score(MD = 0.52,95%CI: 0.30-0.73,P < 0.00001) compared with CLA.No significant differences were found for total complications(RR = 1.15,95%CI: 0.76-1.75,P = 0.51),drain insertion(RR = 0.72,95%CI: 0.41-1.25,P = 0.24),or length of hospital stay(SMD = 0.04,95%CI:-0.08-0.16,P = 0.57).Because there was not enough data among the analyzed RCTs,postoperative pain was not calculated.CONCLUSION: The benefit of SILA is cosmetic satisfaction,while the disadvantages of SILA are longer operative time and higher conversion rate.     

单孔对比传统三孔腹腔镜阑尾切除术治疗急性阑尾炎的多中心回顾性分析：一项倾向性评分匹配研究

目的分析单孔对比传统三孔腹腔镜阑尾切除术治疗急性阑尾炎的临床疗效,行亚组分析探索影响单孔腹腔镜手术时间的因素,明确获益人群。 方法回顾性分析三个中心2019年1月至2021年5月连续收治的急性阑尾炎并行腹腔镜阑尾切除术的患者的临床资料,用倾向性匹配方法消除年龄、性别因素对结果的影响,对比单孔和传统三孔腹腔镜手术时间、术后住院时间、术后并发症的区别,行亚组分析影响单孔腹腔镜手术时间的因素。 结果单孔组的手术时间延长（50.42±10.661 min vs. 37.76±11.023 min,t=6.566,P=0.000）,术后VAS疼痛评分降低（3.42±1.98 vs. 4.44±2.37,t=2.569,P=0.011）、需要使用镇痛药比例降低（8.3% vs. 22.9%,χ²=4.600,P=0.032）、疤痕美容SCAR评分降低（4.59±2.87 vs. 6.74±3.34,t=3.910,P=0.000）,术中出血量、术后住院时间及术后并发症差异无统计学意义。Logistic回归分析发现手术方式、BMI和阑尾直径是影响手术时间的独立影响因素,亚组分析发现BMI对单孔组和三孔组的手术时间均有影响,但对单孔组的影响更大;阑尾直径对三孔组的手术时间有影响,不影响单孔组的手术时间。 结论单孔腹腔镜阑尾切除术治疗急性阑尾炎是一种安全、有效的方法,可减少术后疼痛,术后腹壁疤痕更美观,尤其在BMI正常、阑尾直径较大的患者中效果更佳。     

Postcolonoscopy appendicitis in a patient with active ulcerative colitis

Complications due to diagnostic colonoscopy are uncommon and acute appendicitis is a very rare complication of colonoscopy. This poses a diagnostic challenge as the presentation of appendicitis is similar to that of other complications of colonoscopy such as perforation or postpolypectomy syndrome. It is hypothesized that postcolonoscopy appendicitis might be associated with obstruction of the appendiceal lumen with fecal matter during colonoscopy. None of the previous reports in the literature have described findings of appendicitis after colonoscopy in a patient with active ulcerative colitis. We present a case of a 28 year-old man with active ulcerative colitis who underwent colonoscopy and subsequently developed acute appendicitis.     

Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis

AIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. METHODS: The demographic and histopathological data of 1621 patients (≥ 16 years-old) who underwent appendectomy to treat an initial diagnosis of acute appendicitis between January 1999 and November 2011 were retrospectively assessed. Microscopic findings were used to classify the patients under six categories: appendix vermiformis, phlegmonous appendicitis, gan- grenous appendicitis, perforated appendicitis, supurative appendicitis, and unusual histopathologic findings. The demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and re-analysis of archived resected appendix specimens was carried out. RESULTS: A total of 912 males and 709 females, from16 to 94 years old, were included in the study and comprised 789 cases of suppurative appendicitis, 370 cases of appendix vermiformis, 243 cases of perforated gangrenous appendicitis, 53 cases of flegmaneous appendicitis, 32 cases of gangrenous appendicitis, and 134 (8.3%) cases of unusual histopathological findings. The unusual histopathological findings included fibrous obliteration (n = 62), enterobius vermicularis (n = 31), eosinophilic infiltration (n = 10), mucinous cystadenoma (n = 8), carcinoid tumor (n = 6), granulomatous inflammation (n = 5), adenocarcinoma (n = 4; one of them mucinous), and mucocele (n = 3), adenomatous polyp (n = 1), taenia sup (n = 1), ascaris lumbricoides (n = 1), appendiceal diverticula (n = 1), and B cell non-hodgkin lymphoma (n = 1). None of the 11 patients with subsequent diagnosis of tumor were suspected of cancer prior to the appendectomy. CONCLUSION: Even when the macroscopic appearance of appendectomy specimens is normal, histopathological assessment will allow early diagnosis of many unusual diseases.     

阑尾血吸虫病并发急性阑尾炎临床分析

回顾性分析275例阑尾血吸虫病并发急性阑尾炎患者的临床资料,结果表明血吸虫病流行区阑尾血吸虫病并发急性阑尾炎发病率较高,并发症严重,应引起高度重视。     

Clinical and computed tomography findings of appendiceal diverticulitis vs acute appendicitis

AIM: To study the clinical features and computed tomography(CT) findings of appendiceal diverticulitis vs acute appendicitis.METHODS: We retrospectively reviewed the records of 451 patients who had undergone appendectomy inour in stitution from January 2007 to September 2012. Patient demographics, clinical features, pathological findings, and surgical outcomes were analyzed. We also compared preoperative CT images of 25 patients with appendiceal diverticulitis with those of 25 patients with acute appendicitis.RESULTS: Among 451 patients, 44(9.7%) were diagnosed to have appendiceal diverticulitis and 398(86.9%) to have acute appendicitis. Patients with appendiceal diverticulitis were older(59 vs 37 years, P < 0.001) and had a longer duration of the illness(4.0 d vs 1.0 d, P < 0.001). Perforation rates in patients with appendiceal diverticulitis were higher(68% vs 27%, P < 0.001). The appendix could be visualized in only 13 patients(52%) among the appendiceal diverticulitis cases, but in all acute appendicitis cases. CT findings suggestive of appendiceal diverticulitis included the absence of fluid collection in the appendix(84% vs 12%, P < 0.001), absence of appendicolith(92% vs 52%, P = 0.005), and formation of abscess(68% vs 16%, P < 0.001). Appendiceal diverticula were identified in 6 patients(24%).CONCLUSION: Among patients who had undergone appendectomy, 9.7% had appendiceal diverticulitis. Patients with appendiceal diverticulitis had different clinical features and CT findings from patients with acute appendicitis.     

Seasonal variations of acute appendicitis and nonspecific abdominal pain in Finland

AIM:To investigate whether seasonal changes had an effect on the incidence of acute appendicitis(AA)or nonspecific abdominal pain(NSAP).METHODS:We carried out a national register study of all patients with a hospital discharge diagnosis of AA and acute NSAP in Finland.Data were analyzed for the whole country and correlated to seasonal and weather parameters(temperature,humidity).Moreover,additional sub-analyses were performed for five geographically different area of Finland.RESULTS:The observation period spanned 21 years,with 186558 appendectomies,of which 137528(74%)cases were reported as AA.The incidence of AA declined for 32%over the study period.The average incidence of the NSAP was 34/10000 per year.The mean annual temperature,but not relative humidity,showed clear geographical variations.The incidence of AA decreased significantly during the cold months of the year.No correlation was detected between temperature and incidence of NSAP.Humidity had a statistically significant impact on NSAP.CONCLUSION:The incidence of acute appendicitis is declining in Finland.We detected a clear seasonality in the incidence of AA and NSAP.     

Stump appendicitis is a rare delayed complication of appendectomy： A case report

INTRODUCTIONStump appendicitis is an acute in? ammation of the residual appendix and a rare complication after appendectomy[1]. Although the signs and symptoms do not differ from those of acute appendicitis, the diagnosis is often not considered because o…     

Patient and physician perception of natural orifice transluminal endoscopic appendectomy

AIM: To investigate perception of natural orifice transluminal endoscopic surgery (NOTES) as a potential technique for appendectomy.METHODS: One hundred patients undergoing endoscopy and 100 physicians were given a questionnaire describing in detail the techniques of NOTES and laparoscopic appendectomy. They were asked about the reasons for their preference, choice of orifice, and extent of complication risk they were willing to accept.RESULTS: Fifty patients (50%) and only 21 physicians (21%) preferred NOTES (P < 0.001). Patients had previously heard of NOTES less frequently (7% vs 73%, P < 0.001) and had undergone endoscopy more frequently (88% vs 36%, P < 0.001) than physicians. Absence of hernia was the most common reason for NOTES preference in physicians (80% vs 44%, P = 0.003), whereas reduced pain was the most common reason in patients (66% vs 52%). Physicians were more likely to refuse NOTES as a novel and unsure technique (P < 0.001) and having an increased risk of infection (P < 0.001). The preferred access site in both groups was colon followed by stomach, with vagina being rarely preferred. In multivariable modeling, those with high-school education [odds ratio (OR): 2.68, 95% confidence interval (CI): 1.23-5.83] and prior colonoscopy (OR: 2.10, 95% CI: 1.05-4.19) were more likely to prefer NOTES over laparoscopic appendectomy. There was a steep decline in NOTES preference with increased rate of procedural complications. Male patients were more likely to consent to their wives vaginal NOTES appendectomy than male physicians (P = 0.02).CONCLUSION: The preference of NOTES for appendectomy was greater in patients than physicians and was related to reduced pain and absence of hernia rather than lack of scarring.     

Laparoscopic appendectomy: State of the art. Tailored approach to the application of laparoscopic appendectomy?

Acute appendicitis is the most common surgical emergency in developed countries. The treatment of acute appendicitis is either open or laparoscopic appendectomy. The latter has gained wide acceptance in the past years, although the debate on the true merits of laparoscopic appendectomy is still on going. Some authors prefer this approach as the gold standard for all patients, but in our opinion a tailored approach is warranted for specific patient groups. In addition, a standardised guideline on the technical aspects is still lacking. In the current article, open versus laparoscopic appendectomy and several technical aspects, such as stump closure, appendix extraction and single incision are discussed laparoscopic appendectomy are being addressed. In the future perspectives we will briefly discuss the third ‘newly’ introduced antibiotic treatment.     

内镜下逆行阑尾炎治疗术治疗急性非穿孔性阑尾炎疗效对比的Meta分析

目的 系统性评价内镜下逆行阑尾炎治疗术(ERAT)治疗急性非穿孔性阑尾炎的安全性和有效性.方法 检索Pubmed、Cochrane图书馆对照试验注册库、中国期刊全文数据库、万方数据库、维普数据库,自2012年1月至2019年4月有关内镜下逆行阑尾炎治疗术和腹腔镜手术治疗急性非穿孔性阑尾炎的相关文献,采用Cochrane...     

Prospective, randomized trial comparing laparoscopicvs. conventional surgery for refractory ileocolic crohn's disease

INTRODUCTION: Surgeons have been reluctant to apply laparoscopic techniques to Crohn's disease surgery because of concerns with evaluating and excising inflamed tissue using laparoscopic methods Additionally in Crohn's disease surgery, laparoscopic techniques have not been demonstrated to have clear advantages over conventional ones. METHOD: We conducted a prospective, randomized trial in one surgical department comparing laparoscopic vs. conventional techniques in 60 patients (25 males), median age 34.4 (range 10–60.1) years, undergoing elective ileocolic resection for refractory Crohn's disease. Postoperatively, all patients underwent measurement of pulomnary function tests every 12 hours, and were treated identically on a highly controlled protocol with regard to analgesic administration, feeding, and postoperative care. RESULTS: Of the 31 patients assigned to laparoscopic and 29 to the conventional group, all had isolated Crohn's disease of the terminal ileum plus or minus the cecum. Median length of the incision was 5 cm in the laparoscopic group and 12 cm in the conventional group. Overall recovery of 80 percent of forced expiratory volume (one second) and forcec vital capacity was a median of 2.5 days for laparoscopic and 3.5 days for conventional (P=0.03). There was no difference in the amount of morphine equivalents used between groups postoperatively. Flatus and first bowel movement returned a median of 3 and 4 days, respectively, after conventional roscopicvs. 3.3 and 4 days, respectively, after conventional surgery (P=0.21). Median length of stay was five (range, 4–30) days for laparoscopic, and six (range, 4–18) days for conventional surgery. Major complications occurred in one patient in each group. Minor complications occurred in four laparoscopic and eight conventional patients (P<0.05). There were no deaths. Two laparoscopic patients were converted to conventional as a result of adhesions or inflammation. All patients recovered well and there were no clinical resurrences in the follow-up period (median, 20; range, 12–45 months). CONCLUSIONS: Within a single insititution, single surgical team, prospective, randomized trial, laparoscopic techniques offered a faster recovery of pulomary function, fewer complications, and shorter length of stay compared with conventional surgery for selected patients undergoing ileocolic resection for Crohn's disease.Supported by United States Surgical Corporation, Norwalk, Connecticut, and the Minimally Invasive Surgery Center of the Cleveland Clinic Foundation.Read at The American Society of Colon and Rectal Surgeons' 100th Anniversary and Tripartite Meeting, Washington, D.C., May 1 to 6, 1999.     

Lack of association between appendectomy and primary biliary cirrhosis

Objective Children with inflammatory bowel disease (IBD) suffer from malabsorption and malnutrition and therefore may be at risk of developing polyunsaturated fatty acid (PUFA) deficiency. The aim of this study was to investigate PUFA status in children with IBD and the possible relationship to disease activity and nutritional status.

Material and methods We assessed the fatty acid composition of plasma phospholipids (%wt/wt) of 21 children aged 5.5–18 years with IBD (ulcerative colitis, 15; Crohn's disease, 6) with mild or moderate disease activity. The clinical symptoms and biochemical indices of disease activity and nutritional status (lean and fat body mass, Hb, albumin serum conc.) were also determined.

Results The patients had lower phospholipid PUFAs than 13 healthy, aged-matched controls (25.8±5.2 versus 34.2±5.7, M±SD, p<0.001), mainly due to lower values of linoleic acid (18:2n?6, 14.0±3.8 versus 18.3±4.3, p<0.01) and its major metabolite arachidonic acid (20:4n?6, 5.3±2.0 versus 9.3±1.9, p<0.0001). There were also higher values of α-linolenic acid (18:3n?3, 0.3±0.4 versus 0.2±0.1, p<0.01) while the long-chain n?3 PUFA-eicosapentaenoic and docosahexaenoic acids were normal. Total n?6 PUFA correlated inversely to erythrocyte sedimentation rate (p<0.01), seromucoid (p<0.05) and positively to Hb concentration (p<0.01).

Conclusions Children with inflammatory bowel disease have a high risk of n?6 PUFA depletion, which is related to disease activity.