改良式内镜下逆行阑尾炎治疗术在儿童阑尾炎合并肠套叠的初探（含视频）

探讨改良式内镜下逆行阑尾炎治疗术（endoscopic retrograde appendicitis therapy,ERAT）在儿童急性非复杂性阑尾炎合并肠套叠的有效性和安全性。2018年10月—2020年2月,因急性非复杂性阑尾炎合并肠套叠于唐都医院儿科接受改良ERAT治疗的6例患者纳入回顾性分析,总结肠套叠复位...     

内镜逆行阑尾炎治疗术的临床应用

目的探讨内镜下逆行阑尾炎治疗(Endoscopic Retrograde Appendicitis Therapy,ERAT)对急性阑尾炎的临床诊疗效果及安全性。方法将38例急性阑尾炎患者按自愿原则分为ERAT组(18例)及对照组(20例),ERAT组肠道准备后行结肠镜下逆行阑尾造影术,并用取石球囊清扫阑尾粪石、冲洗阑尾腔、支架引流,而对照组常规行腹腔镜阑尾切除术(laparoscopic appendectomy,LA),比较两组的临床治疗效果及安全性。结果 ERAT组腹痛缓解时间快、平均住院时间短、住院费用低,与对照组有显著差异(P 0. 05)。结论 ERAT对急性阑尾炎具有良好的诊疗价值,具有微创、恢复快及安全,同时保留了阑尾生理功能等优点。     

胆胰管成像系统辅助内镜逆行阑尾炎治疗术在儿童急性阑尾炎中的价值(含视频)

目的探究一次性胰胆管成像系统(eyeMax洞察)辅助内镜逆行阑尾炎治疗术(endoscopic retrograde appendicitis therapy, ERAT)在儿童急性阑尾炎中的应用价值。方法纳入2022年8—11月在西安市儿童医院就诊, 通过影像学检查确诊的11例急性非复杂性阑尾炎患儿。患儿均行子镜辅助ERAT, 子镜进入阑尾腔直视下观察阑尾黏膜, 并通过冲洗、取石、支架引流等措施治疗阑尾炎。记录儿童急性阑尾炎在子镜下的表现及子镜辅助ERAT的治疗成功率、插管成功率、术中及术后并发症等指标。结果纳入的11例患儿年龄(7.93±2.67)岁。患儿均插管成功, 镜下均可见阑尾内口及阑尾腔黏膜充血肿胀, 6例可见腔内粪石, 8例可见脓性分泌物, 6例可见扭曲或狭窄。术中1例合并穿孔, 无其他并发症。患儿均进行子镜下治疗, 包括阑尾腔冲洗(11例)、网篮取石(3例)、阑尾支架引流(2例)。术后患儿症状体征均缓解, 48 h内有效率为10/11。术后随访1周～4个月, 患儿无ERAT相关并发症发生, 无复发。结论一次性胰胆管成像系统辅助ERAT可通过直视下观察阑尾腔诊断急性阑尾炎...     

内镜逆行阑尾炎治疗术与腹腔镜阑尾切除术治疗急性非复杂性阑尾炎的疗效对比研究

目的 比较内镜逆行阑尾炎治疗术(ERAT)与腹腔镜阑尾切除术(LA)在治疗急性非复杂性阑尾炎(UCAA)中的疗效。方法 以2020年8月至2023年8月中山市人民医院黄圃院区消化内科收治的80例急性非复杂性阑尾炎患者作为本研究研究对象,根据患者是否愿意进行ERAT治疗进行分组,将患者分为ERAT组(n=40)和LA组(n=40)。ERAT组行ERAT术,LA组行LA术,比较两组患者手术相关指标(手术时间、术后卧床时间、住院时间、术中出血量)、炎症指标(IL-6、CRP、PCT、TNF-α)及疼痛介质指标(DA、SP、5-HT、PGE2)及术后并发症(消化道出血、切口感染、腹腔脓肿、肠梗阻)发生情况。结果 ERAT组患者的手术时间、术后卧床时间、住院时间均较LA组显着缩短,同时ERAT组的术中出血量也较LA组明显减少(P<0.05)。ERAT组与LA组两组患者的炎症指标(IL-6、CRP、PCT、TNF-α)水平均较术前上升,ERAT组炎症指标(IL-6、CRP、PCT、TNF-α)均显着低于LA组(P<0.05)。ERAT组患者术后并发症发生率明显低于LA组(P<0....     

内镜逆行阑尾炎治疗术对阑尾炎术后感染的预防价值

目的分析内镜逆行阑尾炎治疗术对阑尾炎术后感染的预防价值。方法采用随机数字表将71例急性阑尾炎患者分为2组,观察组35例,行内镜逆行阑尾炎治疗术;对照组36例,行腹腔镜阑尾切除术。对比2组手术指标、术后不良事件、疼痛评分及血清炎性因子水平。结果观察组较对照组手术时间长,术中出血量少,术后卧床时间和住院时间短（P＜0.05）。观察组术后主要不良事件为复发,对照组为感染,2组总并发症发生率差异无统计学意义（P＞0.05）。术后12 h观察组疼痛评分低于对照组（P＜0.05）。术后2组血清超敏C-反应蛋白、白介素1β、白介素6及肿瘤坏死因子α水平均较术前有明显降低,且观察组低于对照组;白介素4和白介素10水平均有明确提高,且观察组高于对照组（P＜0.05）。结论内镜逆行阑尾炎治疗术在维持阑尾炎患者血清炎性因子平衡、预防感染方面可能存在积极作用,具有进一步研究的价值。     

手术治疗合并糖尿病急性阑尾炎效果的临床观察

目的观察急性阑尾炎患者是否合并糖尿病行急诊阑尾切除术治疗的效果,并探讨糖尿病对围术期的影响。方法选择2004—2013年10年间辉南县中医院收治的行急诊阑尾切除术的30例合并糖尿病急性阑尾炎患者为观察组研究对象,随机选择同期收治的行急诊阑尾切除术的30例未合并糖尿病的阑尾炎患者为对照组研究对象,手术选择常规开腹阑尾切除术和腹腔镜阑尾切除术的方法。结果观察组浅表性胃炎低于对照组,坏疽性阑尾炎高于对照组;观察组和对照组术后排气时间分别为（70.2±6.8）和（81.1±7.0）h,观察组术后排气时间（70.2±6.8）h低于对照组（81.1±7.0）h（t=6.11,P〈0.05）;观察组切口感染（8例）低于对照组（2例,χ2=4.32,P〈0.05）;腹腔感染、心律失常和电解质紊乱发生例数差异无统计学意义（P〈0.05）。结论应加强合并糖尿病急性阑尾炎急诊手术治疗时围术期的管理,使患者早日康复。     

内镜下逆行阑尾炎治疗技术介绍

一百多年来,阑尾切除术一直是治疗急性阑尾炎的主要手段[1].近年来,随着内镜微创诊疗技术的发展,许多疾病可以在保留器官的基础上得到有效治疗.美国胃肠内镜协会(ASGE)的官方杂志Gastrointestinal Endoscopy (GIE)近日报道了一种新的微创内镜诊疗技术——内镜下逆性阑尾炎治疗术(endoscopic retrograde appendicitis therapy,ERAT)治疗急性单纯性阑尾炎[2],现将该技术介绍如下. 该技术目前主要适用于急性单纯性阑尾炎的患者,对于可疑有阑尾坏疽、穿孔的患者仍建议手术切除治疗.     

不典型急性阑尾炎的多层螺旋CT诊断价值

目的 探讨多层螺旋CT(MS-CT)在不典型急性阑尾炎中的诊断价值.方法 18例不典型急性阑尾炎患者行CT平扫,5例加CT增强扫描.将原始横断面CT图像用MPR、CPR重建图像.结果 18例不典型急性阑尾炎中,CT诊断为急性单纯性阑尾炎11例(61%),急性阑尾炎并阑尾周围炎4例(22%),急性阑尾炎并阑尾周围脓肿2例(11%),可疑急性阑尾炎1例(6%).结论 MS-CT对临床表现不典型的阑尾炎及其并发症的诊断具有较高的诊断价值.     

急性阑尾炎死亡3例

急性阑尾炎死亡３例彭广福广东省梅州市人民医院普外科５１４０３１主题词阑尾炎分类号Ｒ５７４．６１１病例报告例１男，８岁。因急性阑尾炎在外院行阑尾切除术１周，切口感染、肠瘘入院。入院后经保守治疗无效再次手术，术中见小肠广泛粘连，分离困难。瘘口在回盲部...     

小儿慢性阑尾炎18例报告

报告小儿慢性阑尾炎１８例,其中１６例有典型急性阑尾炎病史。１８例患儿均行手术治疗。术中证实其病因主要为阑尾先天性异常和变异;阑尾腔内粪石、异物、寄生虫（卵）;先天性和后天性阑尾粘连。以上原因导致的阑尾腔不完全阻塞、反复发作和长期刺激是病变的基础,阑尾纤维组织增生和淋巴细胞、嗜酸性粒细胞浸润是其病理特征。认为小儿慢性阑尾炎一旦确诊,不管在发作期或非发作期,均应行手术治疗     

Is it time for global adoption of endoscopic retrograde appendicitis therapy of acute appendicitis?

Acute appendicitis is a common abdominal surgical emergency worldwide. Abraham Groves performed the first documented open appendectomy in 1883. Although appendectomy is still the most effective treatment in cases of acute appendicitis, it causes a range of complications and carries the risk of negative appendectomy. In the awake of covid-19, the latest guidelines recommend antibiotic therapy as an acceptable first line treatment for acute appendicitis. However, patients treated with antibiotics have a recurrence risk of up to 30% at 1 year. Endoscopic retrograde appendicitis therapy (ERAT) has emerged as promising non-invasive treatment modality for acute uncomplicated appendicitis (AUA) which involves cannulation, appedicography, appendiceal stone extraction, appendiceal lumen irrigation, and stent insertion. ERAT aims to relieve the cause of appendicitis (e.g., obstruction or stenosis of the appendiceal lumen) and thus effectively prevent the recurrence of appendicitis. In addition, it can make a definitive diagnosis of acute appendicitis during endoscopic retrograde appendicography. Studies have shown that 93.8 to 95% of AUA patients did not have a recurrence following ERAT. In this study, we aim to summarize the current body of evidence on ERAT to situate it alongside currently established therapies for acute appendicitis, in particular, AUA.     

The role of colonoscopy in the diagnosis of appendicitis in patients with atypical presentations

BACKGROUND: Acute appendicitis is one of the most common causes of acute abdomen. Despite recent advances in radiologic imaging, the diagnosis of acute appendicitis may be difficult on occasion. The aims of this study were to describe the colonoscopic features of appendicitis and to determine whether colonoscopy can be used as an adjunct for the diagnosis of appendicitis in patients with atypical presentations. METHODS: The colonoscopic findings in 21 patients (14 men, 7 women; average age 55 years) with a colonoscopic or histopathologic diagnosis of appendicitis were analyzed retrospectively. Colonoscopy was performed because diagnoses suggested by CT were other than acute appendicitis (11 patients), and/or the presenting clinical features were atypical for acute appendicitis with the duration of symptoms being 10 days or longer (17 patients). RESULTS: The colonoscopic diagnosis was acute appendicitis for all 21 patients. Seventeen underwent appendectomy, the diagnosis being verified in all cases. Of the 4 patients whose symptoms improved without appendectomy, 3 were considered to have acute appendicitis because pus was seen to drain from the appendiceal orifice at colonoscopy. A definite diagnosis could not be made in the remaining 1 patient. Therefore, the diagnosis of appendicitis was considered confirmed in 20 of 21 patients. Colonoscopic findings in these 20 patients included hyperemia (15) and bulging (18) at the appendiceal orifice area with surrounding mucosal edema (19), and drainage of pus from the appendiceal orifice (7). CONCLUSION: Colonoscopy may be useful in the diagnosis of appendicitis when the clinical presentation is atypical for appendicitis and/or imaging studies are nondiagnostic.     

Significance of SIRS score in therapeutic strategy for acute appendicitis

BACKGROUND/AIMS: The surgical indication for acute appendicitis has been discussed diversely. SIRS (systematic inflammatory response syndrome) is a concept that has been advocated as the clinical criteria on inflammatory diseases. The aim of the current study was to elucidate the significance of SIRS score in deciding therapeutic strategies for acute appendicitis. METHODOLOGY: One hundred and twenty-five patients who were admitted with the diagnosis of acute appendicitis were investigated in the current study. The ultimate surgical indication was decided by the physical examination done by the surgeons. Fifty-nine patients were indicated for appendectomy. The relationship between decision for the surgical treatment for acute appendicitis and SIRS score/positive status was investigated. RESULTS: SIRS score of the patients who were treated with appendectomy was significantly higher than that of the patients treated with conservative therapy containing starvation and administration of antibiotics therapy and SIRS positive status in patients treated with appendectomy was also higher than that in patients with conservative therapy. CONCLUSIONS: SIRS score is also useful as objective and auxiliary information to determine the surgical indication for acute appendicitis.     

结核性阑尾炎的诊断与治疗

目的探讨结核性阑尾炎的诊断和治疗方法。方法对１９６８～１９９７年收治的４６５２例阑尾炎中，经病理确诊的１２例（占０２６％）结核性阑尾炎作回顾性分析。结果本组病例的平均发病年龄为３５岁，女性多见，男女比为１∶２，多为继发（７例）。１２例中增殖型７例，溃疡型３例，混合型２例。术前均误诊，术中确诊２例。１２例均手术治疗，单纯阑尾切除７例，盲肠部分切除２例，右半结肠切除１例，合并回盲部淋巴结切除２例，术后抗结核治疗９例。１２例均顺利痊愈，无并发症。结论结核性阑尾炎发病率低，临床表现无特异性，术前确诊困难，要注意术中观察并重视病理检查。应早期手术和术后抗结核治疗，防止并发症产生。     

老年急性阑尾炎病情严重程度的超声评估及其临床应用

目的 探讨高龄急性阑尾炎患者的超声声像图特征与炎症病变严重程度的关系,为临床治疗提供影像学参考.方法 回顾性分析2011年1月至2021年1月中国人民解放军空军特色医学中心经临床及辅助检查诊断为急性阑尾炎、年龄>70岁的患者78例.剔除仅行保守、抗炎治疗患者21例,最终入组患者57例.按超声表现初步分为炎症反应轻、重2...     

Results of laparoscopicvs. conventional appendectomy in complicated appendicitis

BACKGROUND: Although many trials show some advantages of laparoscopic appendectomy over open appendectomy, the value of laparoscopic appendectomy is still controversial. Specifically the question of whether there are benefits of laparoscopic appendectomy over open appendectomy in complicated appendicitis remains to be answered. METHODS: Of 1,106 consecutive appendectomies (717 laparoscopic appendectomies, 330 open appendectomies, and 59 conversions) between 1989 and 1999, the results of 299 patients with complicated appendicitis (defined by perforation, abscess, or peritonitis) were analyzed retrospectively to compare the complications of laparoscopic appendectomy and conversion (intention-to-treat group) with those of open appendectomy. RESULTS: Complicated appendicitis (n=299) was treated by laparoscopic appendectomy in 171 patients, by open appendectomy in 82 patients, and by conversion in 46 patients. Laparoscopic appendectomy and conversion showed fewer abdominal wall complications than open appendectomy (13/217; 6 percentvs. 15/82; 18.3 percent;P<0.003), which led to a decrease of the total complication rate in the intention-to-treat group (21/217; 9.7 percentvs. 19/82; 23.1 percent;P=0.004). The rate of intra-abdominal abscess formation was nearly the same after laparoscopic appendectomy (4.1 percent) and open appendectomy (4.9 percent). The total complication rate was higher in complicated appendicitis than in acute appendicitis (P<0.005) but was independent of the laparoscopic technique. The conversion rate was higher in complicated appendicitis than in acute appendicitis (21.2vs. 2.3 percent;P<0.001). CONCLUSION: In comparison with open appendectomy, laparoscopic appendectomy (by itself and in an intention-to-treat view) leads to a significant reduction of early postoperative complications in complicated appendicitis and therefore should be considered as the procedure of choice.Preliminary results of our first laparoscopically treated patients were presented in 1998 in German (Barkhausen S, Wullstein C, Gross E. Laparoskopische versus konventionelle Appendektomie—ein Vergleich hinsichtlich der frühpostoperativen Komplikationen. Zentralbl Chir 1998;123:858–62).     

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。     

Application of videolaparoscopy methods in the diagnostics and treatment of acute appendicitis]

The article describes an experience of the diagnostics and treatment of 550 patients who were hospitalized with acute appendicitis. Diagnostic laparoscopy was performed for 200 patients with acute appendicitis as a presumptive diagnosis. 350 patients underwent laparoscopic appendectomy. It was possible to avoid ineffective laparotomy in the course of diagnostic laparoscopy in 88% of patients with unclear symptoms of acute appendicitis, and to establish other acute diseases of the abdominal cavity in 12% of cases. Laparoscopic appendectomy can be performed practically at any form of appendix inflammation. It is better to carry out laparoscopic appendectomy using the clip method, and to treat the mesoappendix by monocoagulation.     

Treatment options of inflammatory appendiceal masses in adults

At present, the treatment of choice for uncomplicated acute appendicitis in adults continues to be surgical. The inflammation in acute appendicitis may sometimes be enclosed by the patient’s own defense mechanisms, by the formation of an inflammatory phlegmon or a circumscribed abscess. The management of these patients is controversial. Immediate appendectomy may be technically demanding. The exploration often ends up in an ileocecal resection or a right-sided hemicolectomy. Recently, the conditions for conservative management of these patients have changed due to the development of computed tomography and ultrasound, which has improved the diagnosis of enclosed inflammation and made drainage of intra-abdominal abscesses easier. New efficient antibiotics have also given new opportunities for nonsurgical treatment of complicated appendicitis. The traditional management of these patients is nonsurgical treatment followed by interval appendectomy to prevent recurrence. The need for interval appendectomy after successful nonsurgical treatment has recently been questioned because the risk of recurrence is relatively small. After successful nonsurgical treatment of an appendiceal mass, the true diagnosis is uncertain in some cases and an underlying diagnosis of cancer or Crohn’s disease may be delayed. This report aims at reviewing the treatment options of patients with enclosed appendiceal inflammation, with emphasis on the success rate of nonsurgical treatment, the need for drainage of abscesses, the risk of undetected serious disease, and the need for interval appendectomy to prevent recurrence.     

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...