老年阑尾炎患者腹腔镜阑尾切除效果观察

目的探讨老年阑尾炎腹腔镜微创手术治疗的效果。方法 2005年12月至2009年12月我院收治老年阑尾炎203例,其中腹腔镜阑尾切除术（Laparoscopic appendectomy,LA）72例（LA组）,开腹阑尾切除术（Open appendectomy,OA）131例（OA组）,比较两组病例的手术时间、排气时间、镇痛剂使用、住院时间、术后原发合并症的发生及术后并发症情况。结果 LA组较OA组手术时间、排气时间及住院时间明显缩短,术后镇痛剂应用减少,心肺并发症的发生率及切口感染率较OA组低,差异均有统计学意义（P〈0.05）。结论 LA较OA具有创伤小、肠道功能恢复快、并发症发生率低（如切口感染、粪漏）、住院时间短、能降低心肺并发症的发生等优点,治疗老年人阑尾炎有明显优势。     

Pneumoperitoneum and appendicitis

Pneumoperitoneum was observed in five patients with acute perforative appendicitis (APA). In each case this radiographic observation led to an incorrect diagnosis. Free intraperitoneal gas is found in a small number of patients with APA and has no apparent effect on the course or prognosis of the disease.     

Sonography of acute appendicitis in pregnancy

Background: Clinical evaluation of acute appendicitis is difficult in pregnant patients. Delay in diagnosis is associated with increased fetal mortality. The purpose of our study was to assess the value of sonography in the diagnosis of acute appendicitis in pregnant women. Methods: We obtained sonograms in 22 pregnant women suspected of acute appendicitis. All sonograms were performed using graded-compression to detect an enlarged appendix. The sonographic criteria for acute appendicitis were detection of a noncompressible blindended and tubular multilayered structure of maximal diameter greater than 6 mm. Results: The sonographic findings were correlated with surgical findings in seven cases and clinical follow-up in 15 cases. Acute appendicitis was diagnosed by sonography in three of 22 patients, and in all but one was confirmed by surgical and pathologic findings. In the remaining 19 patients, 15 improved on clinical follow-up; three were shown to have a normal appendix at surgery and one had focal acute inflammation at the tip of the appendix. Conclusions: Our experience suggests that graded-compression sonography is a useful procedure in pregnant patients suspected of acute appendicitis and has a similar accuracy as in nonpregnant women, especially in the first and second trimester.     

Recurrent appendicitis: Reexamination of a controversial disease

The existence of recurrent appendicitis as a true disease entity is still disputed. The controversy surrounding recurrent appendicitis is discussed. This disease is thought to represent repeated inflammation of a nonperforated appendix. Case material supporting this concept is presented. The barium enema can provide evidence of the diseased appendix.     

腹腔镜治疗小儿急性阑尾炎36例

目的探讨腹腔镜在小儿阑尾切除术中的应用价值。方法回顾性分析2005年9月至2006年12月应用腹腔镜三孔法行小儿阑尾切除术36例的临床资料。结果36例均顺利完成手术,手术时间30~90 min,平均50 min。术后3~5 d出院。术后并发穿刺孔周围发生皮下气肿1例,并发腹腔内脓肿1例。28例随访3~15个月,平均9个月,无肠梗阻、腹腔内残余感染等发生。结论腹腔镜小儿阑尾切除术创伤小,并发症少,安全,疗效确切。     

Degenerated uterine leiomyoma mimicking acute appendicitis: Sonographic diagnosis

The present study reviews four cases in which degenerated uterine leiomyomas mimicked appendicitis clinically. The correct diagnosis was made prospectively by sonography in each case. Appendicitis was excluded by graded compression sonography and an exophytic uterine leiomyoma was identified at the point of maximal symptoms. The leiomyomas demonstrated central hypoechoic foci, but no detectable Doppler flow indicating necrosis. Although the phenomenon of a degenerated uterine leiomyoma mimicking appendicitis clinically is known, sonographic diagnosis has not been reported previously. The importance of making this diagnosis sonographically is that management of a degenerated leiomyoma is conservative and unnecessary surgery could be avoided. © 1995 John Wiley & Sons, Inc.     

单孔法与三孔法腹腔镜阑尾切除术治疗儿童单纯性阑尾炎的效果及护理

目的:探讨单孔法与三孔法腹腔镜阑尾切除术(LA)治疗儿童单纯性阑尾炎的效果及护理方法。方法:将190例单纯性阑尾炎患儿随机分为单孔法组92例与三孔法组98例,单孔法组患儿在腹部取脐下半弧型切口手术,三孔法组患儿在腹部取脐下半弧型切口的同时于右下腹及左下腹取切口手术。结果:两组在平均手术时间、术中出血及术后住院时间比较差异有统计学意义(P<0.05);单孔法组较三孔法组明显减少(P<0.05)。术后镇静剂的使用,术后使用镇静剂单孔法LA较三孔法LA明显减少(P<0.05)。结论:单孔法腹腔镜阑尾切除术治疗儿童单纯性阑尾炎达到了损伤更小、手术更快捷、术后痛苦少、恢复快和腹部美容的效果,且减少了护士基础护理的负担。     

An adult intussusception mimicking early appendicitis

Adult intussusception is rare with variable clinical presentation. We reported a case of adult intussusception presenting with symptoms mimicking acute appendicitis. The patient presented as an abdominal pain from epigastric area with shifting gradually to RLQ. The atypical presentation of adult intussusception remains a diagnostic challenge to the emergency physician.     

腹腔镜阑尾切除术126例体会

目的总结腹腔镜阑尾切除术（LA）的临床应用体会。方法回顾分析2007年10月至2010年9月行LA治疗126例阑尾炎患者的临床资料,其中单纯性阑尾炎38例,化脓性及坏疽穿孔性阑尾炎46例,阑尾周围脓肿8例,慢性阑尾炎34例。结果 126例LA均获成功,无一例中转开腹。手术时间20~91 min,平均36.5 min,术中出血2~20 ml。术后仅2例切口感染。住院2~7 d,平均3 d。结论 LA具有创伤小,康复快,并发症少,术后切口平整、美观等优点。     

腹腔镜阑尾切除术治疗特殊类型的阑尾炎的技术分析和研究

目的总结腹腔镜阑尾切除术在特殊类型阑尾炎中的治疗体会。方法3年来该院共有78例特殊类型的阑尾炎患者采取LA，并且随机选择同期95例特殊类型阑尾炎非腹腔镜阑尾切除术作对照，对其手术适应证、手术方法、术后的恢复情况、术后疼痛和并发症及住院时间和费用等进行了回顾性分析。结果78例术后均经病理证实为阑尾炎，5例患者术中探查发现并存有其他疾病并且同时应用腹腔镜治愈，3例术前没有完全确诊，术中经腹腔镜探查确诊，1例因为腹腔广泛粘连而转为开腹。术后患者疼痛感轻微，无切口感染及院内感染，平均住院4．5d，住院费用与同期同类手术的差别无统计学意义。结论LA对于特殊类型的阑尾炎是一种较为理想的手术方式，具有损伤小，恢复快，可避免误、漏诊的优点。     

糖尿病阑尾切除术病人的护理

目的:探讨糖尿病合并阑尾炎病人接受阑尾切除术的围手术期的护理经验,以便提高护理水平。方法:对2005年6月～2009年6月入院的38例糖尿病阑尾切除术病人围术期采取有针对性的护理措施,特别是针对血糖控制采取有效的护理措施。结果:全部病例均治愈,无并发症发生。结论:加强糖尿病阑尾切除术病人围手术期护理,对避免术后并发症,提高手术成功率具有重要意义。     

新生儿阑尾炎临床及超声图像特点分析

目的总结新生儿阑尾的临床及超声图像特点。 方法选取2007年1月至2017年10月在首都医科大学附属北京儿童医院经手术或临床诊断的新生儿阑尾炎28例,总结其临床及超声图像特点。 结果28例新生儿阑尾炎患儿中超声可显示阑尾9例,其中3例阑尾外径<0.4 cm,6例阑尾外径≥0.4 cm;2例阑尾壁厚<0.2 cm,7例阑尾壁厚≥0.2 cm。19例新生儿阑尾显示困难,则重点观察阑尾周围改变。超声扫查提示：28例右下腹可见阑尾周围系膜肿胀,26例可见阑尾周围积脓或炎性包块;超声提示诊断新生儿阑尾炎22例,新生儿坏死性小肠结肠炎4例,消化道穿孔1例;1例因腹胀明显,初诊超声无异常发现,腹胀缓解后超声诊断新生儿阑尾炎。28例患儿中2例继发近端小肠粘连梗阻,2例阴囊内混浊积液。超声随访观察28例新生儿治疗后改变,其中保守治疗21例,18例1个月内超声复查可见周围炎症范围较上次检查缩小（4例5~10个月复发,2例再次手术,2例保守治疗后均好转）。7例手术治疗的患儿中,4例术后1周行超声复查,原病变区局部仅可见少许粘连。 结论新生儿阑尾炎临床症状多样,超声图像表现为阑尾周围系膜肿胀,阑尾外径增大（≥0.4 cm）和（或）阑尾壁增厚（≥0.2 cm）,可合并积脓和（或）炎性包块,超声检查可对患儿的诊断及治疗提供依据。     

急性阑尾炎的超声表现与病理对照分析

目的探讨超声在急性阑尾炎诊断中的应用价值。方法通过对临床诊断为急性阑尾炎行超声检查的218例患者的回顾性分析，比较超声检查、手术及病理结果。结果218例中167例超声诊断为阑尾炎。均为手术、病理所证实；20例为其他急腹症；33例超声检查阴性，其中11例为阑尾炎，8例为单纯性阑尾炎，3例为后位阑尾炎，超声诊断急性阑尾炎的敏感性为94．5％，特异性为100％。结论超声检查是急性阑尾炎简便有效的辅助诊断方法，对可疑病例进行常规检查可明显降低误诊误治率。     

Sonography of ruptured appendicitis

Three girls and 4 boys with the final diagnosis of ruptured appendicitis underwent 19 sonographic studies, 5 before any therapy was instituted and 14 follow-up studies. Four abscesses identified before treatment and 2 seen postoperatively were ovoid, irregularly marginated, and contained lowamplitude echoes. Gastrointestinal ileus with gas- and fluid-filled loops of bowel made the studies technically difficult. Follow-up studies also showed fluid collections distant from the original abscesses. The complete resolution of the abscess was followed sonographically in 1 patient treated with antibiotics. Ultrasound can be useful in confirming or suggesting the diagnosis of ruptured appendicitis in the child with abdominal pain, but careful attention to detail is necessary in these technically difficult studies.     

穿孔性阑尾炎CT征象

目的 探讨阑尾穿孔具有诊断价值的CT征象。方法 回顾性分析205例经手术病理证实的穿孔性和非穿孔性阑尾炎患者的CT图像。观察12项急性阑尾炎的CT征象,采用χ²检验筛选可用于鉴别诊断穿孔性与非穿孔性阑尾炎的CT征象,评价这些征象的敏感度、特异度和准确率。采用Logistic回归分析法分析阑尾穿孔最具诊断价值的CT征象。结果 205例中,40例(40/205,19.51%)阑尾穿孔与165例(165/205,80.49%)阑尾未穿孔患者间,脓肿、阑尾壁强化缺损、蜂窝织炎、阑尾腔外积气、阑尾腔外粪石差异均有统计学意义(P均<0.05),各征象鉴别诊断穿孔性和非穿孔性阑尾炎的敏感度、特异度和准确率依次分别为:脓肿80.00%(32/40)、97.58%(161/165)、94.15%(193/205),阑尾壁强化缺损50.00%(20/40)、98.79%(163/165)、89.27%(183/205),蜂窝织炎37.50%(15/40)、95.76%(158/165)、84.39%(173/205),阑尾腔外积气27.50%(11/40)、99.39%(164/165)、85.37%(175/205),阑尾腔外粪石5.00%(2/40)、100.00%(165/165)、81.46%(167/205),Logistic回归分析显示脓肿、阑尾壁强化缺损与阑尾穿孔相关(Wald=33.21、16.19,P均<0.001)。结论 脓肿、阑尾壁强化缺损是阑尾穿孔最有诊断价值的CT征象。     

A child with appendicitis after appendectomy

Stump appendicitis, although rare, is a real entity that is often not considered during the evaluation of children with right lower quadrant pain and a surgical history of appendectomy. The history of appendectomy in a child may delay the diagnosis and management of this entity by misleading the physician into thinking that this patient could never have appendicitis again. However, the diagnosis of appendicitis should be considered in any patient with right lower quadrant pain, even if there is a history of appendectomy. We report a case of stump appendicitis 2 years after laparoscopic appendectomy. A review of the pertinent literature is included.     

CT误诊血吸虫性异位阑尾炎1例

患者男,56岁,因"持续性右上腹疼痛8天"入院,无恶心、呕吐、腹胀、腹泻等症状。当地医院行B超检查示右肾结石,予输液治疗后症状缓解,近5天来患者右上腹隐痛,未排便。专科检查:于右侧肋弓下触及约3.0cm×3.0cm包块,质韧,边界不清,活动、压痛。实验室检查:白细胞、中性粒细胞绝对值、红细胞、血红蛋白均升高。CT示结肠肝曲不规则增厚变形,边界不整,管腔不规则狭窄,管壁不规则增厚并形成肿块(图1),约     

Diagnosing granulomatous disease during appendectomy

Difficulties during surgery are uncommon situations in appendectomy. For granulomatous appendicitis, literature is insufficient about surgical findings. The procedure of a 17‐year‐old male patient was a struggle due to adhesions. I thought a surgeon could expect granulomatous diseases by evaluating the macroscopic appearance of the appendix during surgical procedure.     

Acute recurrent appendicitis with appendicolith

Appendiceal disease can be acute, acute recurrent, or chronic. Acute appendicitis is the most common form. Acute recurrent appendicitis is more common than chronic appendicitis. In children the clinical manifestations of appendicitis are variable. Patients who have an appendicolith usually develop appendicitis, often with perforation. A case is presented of 3-year follow-up of a patient with an appendicolith and acute recurrent appendicitis. The literature about appendicoliths is reviewed. In the appropriate clinical setting, a history of prior episodes of similar right lower quadrant pain does not preclude the diagnosis of appendiceal disease. Awareness of the less common forms of appendicitis is important so that appropriate treatment is not delayed.