高频超声对不同病理类型急性阑尾炎及并发症的诊断价值

目的:探讨高频超声检查对不同病理类型阑尾炎及并发症的诊断价值。方法:分析经超声诊断并经手术病理证实的385例急性阑尾炎的超声特点,主要观察不同类型阑尾炎的阑尾直径大小及阑尾壁层结构的改变。结果:研究急性单纯性阑尾炎81例,急性化脓性阑尾炎228例,急性坏疽性阑尾炎76例,以急性化脓性阑尾炎最高发,并发单纯穿孔18例,合并阑尾周围脓肿9例(其中3例合并腹盆腔脓肿),阑尾炎性包块5例。在不同病理类型阑尾炎的超声表现中,随着阑尾直径的增大,阑尾壁层结构受损程度的加重,阑尾的炎症越重。结论:高频超声对不同病理类型急性阑尾炎及并发症的诊断具有重要价值。     

Complications of wound healing after appendectomy. Medical and economic aspects]

The incidence of hospital and posthospital wound complications was studied in 236 patients, residents of Zelonograd, who underwent operation for acute appendicitis. The material was collected at City Hospital No. 3 and four out-patient clinics of Zelenograd. The incidence of suppuration of the surgical wound in the hospital period was 13.1%, that of nonpurulent complications was 9.3%, and the total incidence of the wound complications was 22.4%. In the posthospital period additional suppuration of wounds was encountered in 23.3% of patients, nonsuppurative wound complications in 17.1%, and the total incidence of posthospital wound complications was 40.3%. The frequency of rehospitalization was 5.5%, the incidence of postoperative hernias was 0.9%. The economical loss due to the development of wound complications in 236 patients operated on for acute appendicitis came up to 56,120 roubles.     

Prophylaxis and treatment of postoperative complications in peritonitis of appendicular genesis

The results of treatment of postoperative complications in 227 children with destructive forms of appendicitis and appendicular peritonitis were analyzed. The expediency of the low-intensive laser radiation application in the treatment of various forms of peritonitis was noted. The frequency of the postoperative complications occurrence was 17.3% at average, constituting one half in comparison with the control groups.     

Acute appendicitis: Prospective trial concerning diagnostic accuracy and complications

In a prospective trial comprising 202 patients operated on because of suspicion of acute appendicitis, the diagnostic accuracy was 70 percent based on histologic examination of all removed appendices. The diagnostic accuracy was lowest in women less than 50 years old and in young patients (aged 20 years or less), being about 60 percent in both of these groups. The reasons were gynecologic disorders and uncharacteristic abdominal pains, respectively. Twenty-three of the 142 patients with acute appendicitis had perforation (16 percent). The frequency of perforation was significantly higher in patients more than 50 years old.Postoperative complications were seen in 11 percent of the patients. There was no significant difference in the frequency of complications in patients with a normal appendix and no other surgical abdominal disorder and patients with nonperforated appendicitis. However, there was a statistically significant difference between these two groups and the group with perforated appendicitis. In the latter group, postoperative complications occurred in 39 percent of the patients as opposed to 4 percent and 8 percent, respectively, in the former groups.     

Combined use of modified Alvarado score and USG in decreasing negative appendicectomy rate

Introduction

Appendicitis is notorious in its ability to simulate other conditions and in the frequency it can be mimicked by other pathologies. Despite extraordinary advances in modern radiography imaging and diagnostic laboratory investigations the accurate diagnosis of acute appendicitis remains an enigmatic challenge. Of the various commonly used diagnostic aids for appendicitis, no single test can reduce the rate of negative appendicectomy to zero.

Materials and methods

Fifty admitted cases of suspected appendicitis were subjected to ultrasonography (USG). All the patients were scored out of 9 according to modified Alvarado score. A treatment plan was devised according to which patients with modified Alvarado score ≥7 underwent immediate appendicectomy even if USG was negative for appendicitis and patients with score <7 underwent appendicectomy if USG was positive for appendicitis.

Result

84.3% of males and 44.4% of females admitted as case of suspected appendicitis had confirmed appendicitis. Due to high sensitivity (97.14%) and accuracy (92%) of our diagnostic approach, 85.71% cases of appendicitis were diagnosed in early stage, with only 8.57% perforation and abscess rate, leading to post appendicectomy complication rate of only 5.14% in our study (one wound infection and one urinary retention). We could achieve low negative appendicectomy rate of 7.14% in males and 11.11% in females and overall 8.11% in our study.

Conclusion

Combined use of modified Alvarado score and high frequency USG not only reduces negative appendicectomy rate but also reduces morbidity and postoperative complications.     

Causes of suppurative complications after appendectomy

The causes of purulent complications in 9,518 patients after appendectomy were studied. The total percentage of purulent complications was 8.0 (6.4 among males and 10.1 among females). It is shown that the form of appendicitis (phlegmonous in 2.0% of males and in 2.0% of females and perforating in 17.7% and 44.9%, respectively) and the time from the onset of the disease to the operation (less than 6 hours in 4.0% of males and in 6.1% of females; more than 48 hours in 11.7% and 18.8%, respectively) have an effect on the frequency of purulent complications. The authors revealed a correlation between the frequency of purulent complications and some factors (the time spent by the patients in the clinic before the operation, surgical team with an incomplete staff, insufficient anesthesia, insufficient operative approach, irrational use of gauze tampons and antibiotics.     

Complications of acute appendicitis and the duration of temporary disability

According to the data of the surgical unit of the Central Clinical Hospital, Ministry of Social Security, MPR during 1977-1983 294 patients had complications (26%) out of 1112 patients with acute appendicitis and appendectomy who were treated in this unit. The common complications are localized, while general and uncommon peritonitis had a diffuse form. An average hospitalization of patients with acute appendicitis complications makes up 18.6 beds per day, patients without acute appendicitis complications--9.8 beds per day. Complicated forms of acute appendicitis are the basic cause of an increased duration of hospitalization of patients and longer duration of timely disablement.     

The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis

BACKGROUND: Negative appendectomy (NA)--the nonincidental removal of a normal appendix--occurs commonly but the associated clinical- and system-level costs are not well studied. HYPOTHESIS: The frequency of adverse clinical outcomes and associated financial burden of hospitalizations during which NA is performed is greater than previously recognized and varies widely among demographic groups. DESIGN: Population-based, retrospective cohort study. SETTING: The 1997 Nationwide Inpatient Sample of the Health Care Utilization Project. PATIENTS: All surveyed patients assigned International Classification of Diseases, Ninth Revision procedure codes for appendectomy but without an associated diagnosis of acute appendicitis. MAIN OUTCOME MEASURES: The age- and sex-stratified rates of NA, the incidence of associated infectious complications and case fatality, and the average length of stay and hospitalization charges during those admissions. RESULTS: Nationwide, an estimated 261 134 patients underwent nonincidental appendectomies in 1997, and 39 901 (15.3%) were negative for appendicitis. Women had a higher rate of NA as did patients younger than 5 years and older than 60 years. When compared with patients with appendicitis, NA was associated with a significantly longer length of stay (5.8 vs 3.6 days, P<.001), total charge-admission ($18 780 vs $10 584, P<.001), case fatality rate (1.5% vs 0.2%, P<.001), and rate of infectious complications (2.6% vs 1.8%, P<.001). An estimated $741.5 million in total hospital charges resulted from admissions in which a NA was performed. CONCLUSIONS: There are significant clinical and financial costs incurred by patients undergoing NA during the treatment of presumed appendicitis. These should be considered when evaluating system-level interventions to improve the management of appendicitis.     

Complications of acute appendicitis in children]

Among 976 children with acute appendicitis 966 were operated upon, 169 of them (17.4%)-for common appendicitis, 401 (41.2%)-for phlegmonous appendicitis, 396 (40.4%)-for gangrenous appendicitis; 10 children were subjected to surgery due to the presence of appendicular infiltration. Preoperatively, in 137 (13.7%) patients peritonitis was observed: local-in 90, diffuse and progressive-in 47. There was noted a dependence of complications on the terms of the disease and patients' stay at the hospital prior to surgery. Following the operation in 98 (10.1%) patients different complications were observed: the postoperative wound suppuration (61), inflammatory processes in the abdomen (infiltrations, abscesses-in 33), intestinal obstruction (2), intra-abdominal hemorrhage (1), enteric fistula (1). There were no lethal issues. The preoperative complications were conditioned by gravity and advanced forms of the principal lesion, technical drawbacks in operation and treatment of purulent peritonitis.     

Immunologic and bacteriologic study of severe acute appendicitis. Diagnostics and therapeutic considerations

Acute appendicitis remains an up to date issue, being the most frequent cause of surgical acute abdomen round the globe. The complications that occurs creates important therapeutically difficulties. The study, based on 114 cases, had analyzed not only the pathogen flora (type, association, frequency of certain germs, the relation between them and different pathological lesion), but also the immune response of the organism to septic aggression. The microbiological tests from the lumen and bont of the appendix and also from peritoneal cavity showed monobacterial infection (11%) and pluribacterial infection (89%). Association between aerobes and anaerobes germs was identified in 85%. The most frequent germs identified were E. coli (87%) and Bacteroides (55%). We didn't identify germs with particular pathogenesis and the immune response had no malfunction. We can conclude that time factor is the main element in constituting of complications during acute appendicitis. A late diagnosis and also a late surgical intervention are the bases for the gravity of the pathogenic process.     

Selective versus routine antibiotic use in acute appendicitis.

Whether prophylactic antibiotics should be employed routinely in all patients with presumed appendicitis rather than be administered selectively to those with suspected perforation remains a controversial issue. The outcome of 312 adult patients undergoing appendectomy during periods of selective (I, n = 153) and routine (II, n = 159) antibiotic use were compared. Although the rates of misdiagnosis were comparable (9% vs 13%), significantly more patients with appendicitis in Period II had perforated appendicitis (29 of 139 vs 44 of 139, P less than 0.05). Prophylactic antibiotics were given to 43 (28%) patients in Period I compared to 132 (83%) in Period II (P less than 0.001). This, increased frequency was true for both simple (21% vs 81%, P less than 0.001) and perforated (66% vs 86%, P less than 0.05) appendicitis. A single antibiotic, most frequently a cephalosporin, was used significantly more often in Period II (44% vs 82%, P less than 0.001). There was no significant difference in the methods of wound closure between the two periods. The incidence of infectious complications was similar in patients with simple appendicitis in both periods (8% vs 11%), but it was significantly greater during Period I in patients with perforated appendicitis (45% vs 20%, P less than 0.05). The overall infection rate was similar in both periods (16% vs 22%). Thus, high-risk patients with perforated appendicitis were more likely to receive antibiotics and had a lower infection rate with routine antibiotic use. Furthermore, there was no overall change in the infection rate during this period, despite the use of less toxic, single drug regimens and a greater percentage of perforated appendicitis.     

Laparoscopic appendectomy is feasible for the complicated appendicitis

We reviewed the results of 339 consecutive appendectomies, including perforated appendicitis, to assess the advantages of the laparoscopic approach for acute appendicitis. Three hundred and eighty-eight patients underwent appendectomy at the Keimyung University Kyungju Dongsan Hospital between March 1994 and June 1996; 339 patients were treated using laparoscopic appendectomy (LA), and 49 patients who were treated with open appendectomy. Special emphasis was given to the results of LA in 27 patients with perforated appendicitis. The mean duration of the operating time for LA was 48.9 minutes. For six patients (1.8%), the procedure was converted to open surgery. Minor complications developed in eight patients (2.4%). There were no complications in the 27 patients with perforated appendicitis. Our experience with LA in perforated appendicitis is limited, but our results show that LA is a safe and acceptable procedure for all forms of acute appendicitis.     

Clinical assessment of immune parameters at surgical patients with syndrome of systemic inflammatory reaction

Results of immunological examination of 423 patients with syndrome of systemic inflammatory reaction of different ethiology (mediastinitis--78 patients, peritonitis--85, severe acute pancreatitis--91, trauma of thorax and abdomen complicated with massive hemorrhage--111, severe burn trauma--40 patients) are analyzed. For complex and objective assessment of immune reaction the system of scores has been developed. This scale permitted to detect the immune disorders, to diagnose the degree of immune insufficiency at early stages of disease, to predict the purulent complications and to start timely immune therapy.     

阑尾炎延迟手术与其病理分型及术后并发症的关系

目的探讨急性阑尾炎手术患者就诊前时段、就诊时段、住院后手术时段与阑尾病理分型及术后并发症的关系 .方法对 2 052例手术和病理确诊的急性阑尾炎患者 ,将术前 12个变量数据化后 ,建立数据库 , SAS软件分析各变量与阑尾病理分型及术后并发症的关系 .结果 (1)就诊前延迟：单纯性阑尾炎平均 23 4 h,进展性 35 3 h;无并发症组 23 1 h,有并发症组 34 4 h(两者 P=0.0001) . (2)就诊间延迟：单纯性阑尾炎平均 2 3 h,进展性 3 3 h( P >0 05);无并发症组 2 3 h,有并发症组 3 0 h( P=0 0499) . (3)住院后手术延迟：单纯性阑尾炎平均 2 7 h,进展性 2 6 h;无并发症组 2 7 h,有并发症组 2 9 h(两者 P >0 05) . (4)logistic回归分析示： 3个时段中 ,就诊前延迟是最有意义的变量 .结论就诊前延迟是影响急性阑尾炎病理分型和术后并发症的主要因素 ,而就诊间延迟、住院后手术延迟影响不大 .     

Laparoscopy in complicated pediatric appendicitis.

BACKGROUND: Complicated appendicitis (gangrenous or perforated) has been associated with increased risk for postoperative complications, especially intraabdominal abscess. Caution has been advised when attempting laparoscopic appendectomy for complicated appendicitis in children. The objective of our study was to assess the incidence of intraabdominal abscess formation after laparoscopic appendectomy in pediatric patients presenting with complicated appendicitis. METHODS: This is a retrospective review of 52 pediatric patients presenting with acute appendicitis at a single teaching institution who underwent laparoscopic appendectomy by a single surgeon. All laparoscopic procedures were completed without conversion. Treatment complications and outcomes were recorded for all cases. RESULTS: Five of the 52 patients (10%) had complicated appendicitis. One of the 5 patients (20%) developed intraabdominal abscess postoperatively and underwent laparoscopic drainage during the same admission. No other complications were noted. None of these patients was readmitted for wound infections or intraabdominal abscesses. The single postoperative abscess occurred early during our initial experience with laparoscopic appendectomy. CONCLUSION: Laparoscopic appendectomy seems to be a safe alternative for the treatment of complicated appendicitis in children. Caution is recommended during the initial experience of surgeons with this procedure, because the complication rate seems to be higher during the learning curve. Close postoperative follow-up and a high index of suspicion for development of complications is recommended. As surgeons' experience accumulates, the safety of the procedure seems to increase. A prospective, randomized trial is recommended to establish the role of laparoscopy in complicated appendicitis in the pediatric population.     

The possibilities of application of iodinedicerinum in urgent surgery

Application of ioddicerynum while performance of an urgent operative intervention in 63 patients with an acute appendicitis, perforated gastroduodenal ulcer and an old postoperative abscess of anterior abdominal wall had permitted to lower the occurrence frequency for postoperative purulent complications by two times.     

Acute Amebic Appendicitis

Introduction Acute appendicitis of amebic origin is considered a rare cause of acute appendicitis. Methods The clinical notes for 4093 patients over the age of 16 who had undergone appendectomy were reviewed. Particular attention was paid to the histopathologic results, separating out those cases where trophozoites were seen in the appendix. These cases were considered to be of amebic origin. Results A total of 93 cases reported lesions suggestive of amebiasis (2.3%). This study analyzed 86 of these cases. Comparing the cases in this study against the cases of patients with acute appendicitis in general (excluding the cases of amebic origin), no differences were found in relation to the distribution or presentation according to sex or in the degree of inflammation of the appendix, the incidence of surgical wound infection, or general complications. By contrast, the study noted a statistically significant difference in the age at presentation: Acute appendicitis of amebic origin presents principally among those under 20 years of age and is accompanied by a higher frequency of fecal fistula (2.3%). Conclusions Acute appendicitis of amebic origin is not seen frequently, and in general it does not behave any differently from other cases of acute appendicitis, except in its earlier presentation and its greater incidence of fecal fistula. The condition is suspected clinically whenever a cecum of hard, “cardboard-like” consistency is discovered.     

Use of acupuncture for restoring motor and transit functions of the stomach and intestines in suppurative peritonitis

With the aim of restoration of motor-evacuatory function of the stomach and intestine, the acupuncture was used in 220 patients with purulent peritonitis. The positive effect after single procedure was noted in all the patients with local peritonitis. In 100 patients with diffuse peritonitis, 2-3 procedures were required to achieve clinical effect. There was no effect in 20 patients. The total lethality was 9.1%, in diffuse forms of peritonitis--14%.     

腹腔镜手术治疗急性阑尾炎72例报告

目的探讨腹腔镜手术治疗急性阑尾炎的价值. 方法对54例急性化脓性阑尾炎、18例阑尾炎穿孔并腹膜炎行腹腔镜手术治疗,并与同期72例阑尾炎开放手术比较. 结果腹腔镜组的并发症发生率、肠功能恢复时间及平均住院日分别为0,0.5 d,2.3 d,对照组分别为15%,2.5 d,6.8 d,两组比较有显著差异. 结论与开放手术比较,腹腔镜治疗急性化脓性阑尾炎及阑尾穿孔性腹膜炎有并发症少,术后恢复快的优势.     

Is there a chronic appendicitis in childhood? Analysis of pediatric surgical patients from 1993-1997

The right lower quadrant abdominal pain and the "chronic" appendicitis in childhood and adolescence are frequently connected with a lot of different diagnostical problems for the treating physician. Since the introduction of diagnostical laparoscopy and laparoscopical appendectomy in our hospital the rate of appendectomy has been increased to 35% in case of the histological diagnosis of "chronic" appendicitis. A special problem in childhood and adolescence is the request of the parents for clarification of chronic recurrent pain in their children and therefore the demand of laparoscopy and not seldom appendectomy. After appendectomy with the pathological-histological findings of "chronic" appendicitis children are in 83% without any abdominal pain. Therefore the question arises whether there exists a "chronic" appendicitis in childhood justifying surgery in these cases. Although the rate of complications and conversions (3.8%) in diagnostical laparoscopy and laparoscopical appendectomy is quite low the indication should only be made after careful examination considering differential diagnostical problems. In our hospital 56.5% of the children with the histological diagnosis of "chronic" appendicitis suffered retrospectively on other diseases, that had been caused the symptoms of appendicitis. Before operation the patients should be informed on the complications in detail.