内镜逆行阑尾炎治疗术诊治急性阑尾炎的初步尝试

目的:探讨内镜逆行阑尾炎治疗术(endoscopic retrograde appendicitis therapy, ERAT)诊治急性阑尾炎的临床意义。方法:回顾性分析2018年1月至2019年9月复旦大学附属金山医院收治的30例行ERAT治疗的急性单纯性、化脓性、穿孔性阑尾炎和阑尾周围脓肿患者的临床资料。术后通过门诊或电话进行随访,分析ERAT治疗成功率、治疗后情况以及随访情况。结果:在30例急性阑尾炎患者中,ERAT成功治疗29例,成功率为96.7%(29/30)。此29例患者腹痛症状均即刻缓解。随访过程中,1例患者复发,复发率为3.4%(1/29)。结论:ERAT可有效、安全地治疗急性阑尾炎。     

内镜下逆行阑尾炎治疗术治疗急性非复杂性阑尾炎的疗效观察及对炎症因子的影响*

目的 探讨内镜下逆行阑尾炎治疗术(ERAT)治疗急性非复杂性阑尾炎的临床疗效及对血清炎症因子水平的影响。方法 收集2017年1月-2018年9月广东省东莞市第八人民医院收治的急性非复杂性阑尾炎患者40例,随机分为研究组(n=20)和对照组(n=20)。研究组采用ERAT,对照组采用腹腔镜阑尾切除术(LA),比较两组患者的手术结果、并发症发生情况和手术前后血清白细胞介素-6(IL-6)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)等血清炎症因子水平的变化。结果 研究组术后下床活动时间、住院天数、手术时间和体温恢复正常时间明显少于对照组(P0.05);研究组术后消化道出血、切口感染、腹腔脓肿和肠梗阻等并发症发生率明显低于对照组患者(P0.05);两组患者术后IL-6、PCT、TNF-α和CRP等指标较术前升高,研究组(ERAT组)IL-6、PCT、TNF-α和CRP等指标均明显低于对照组(LA组)(P0.05)。结论 ERAT治疗急性非复杂性阑尾炎安全有效,疗效好,能降低术后并发症的发生率,保护阑尾结构的完整性,降低血清炎症因子水平,减少对患者阑尾的伤害,缩短住院时间,促进患者恢复,改善生活质量。     

内镜逆行性阑尾炎治疗术治疗急性单纯性阑尾炎的临床疗效观察

目的 探讨内镜逆行性阑尾炎治疗术（ERAT）在急性单纯性阑尾炎患者治疗中的应用效果。方法 选取2020年5月至2022年6月我院收治的88例急性单纯性阑尾炎患者的，按不同手术方法 分为对照组和观察组各44例。对照组给予腹腔镜阑尾切除术（LA），观察组采用ERAT。对比两组围术期指标、炎症因子、并发症发生率。结果 观察组手术时间、术后下床活动、首次进食时间、白细胞恢复正常时间、体温恢复正常时间、住院时间均短于对照组，差异有统计学意义（P<0.05）。治疗前，两组炎症因子水平比较，差异无统计学意义（P>0.05）；治疗后，观察组白介素-6(IL-6)水平、C反应蛋白（CRP）水平、肿瘤坏死因子-α(TNF-α)水平、降钙素原（PCT）水平均低于对照组，差异有统计学意义（P<0.05）。观察组并发症发生率为4.55%，低于高于对照组的18.18%，差异有统计学意义（P<0.05）。结论 ERAT在急性单纯性阑尾炎患者中治疗效果显著，具有手术时间短、术后恢复快、并发症少等优点。     

内镜下逆行阑尾炎治疗术治疗急性非复杂性阑尾炎疗效的Meta分析

目的评价内镜下逆行阑尾炎治疗术治疗急性非复杂性阑尾炎的临床价值。方法通过计算机检索PUBMED、CNKI数据库、Web of Knowledge、Cochrane图书馆对照试验注册库和万方数据库从建库至2018年6月的有关内镜下逆行阑尾炎治疗术治疗急性非复杂性阑尾炎的相关文献,采用Cochrane协作网提供的Rev Man 5.0版软件进行统计处理,对纳入资料的异质性进行分析,计算O^R值或MD值及其95%可信区间(95%CI)。结果按照入选标准,纳入了8项临床试验,共537例患者。Meta分析结果显示,内镜下逆行阑尾炎治疗术治疗急性非复杂性阑尾炎住院时间短(MD=-2.11,95%CI:-3.10～-1.11,P 0.05)、并发症发生率低(O^R=0.27,95%CI:0.13～0.56,P 0.05)、手术时间短(MD=-23.46,95%CI:-29.97～-16.96,P 0.05)。结论目前的研究结果显示,内镜下逆行阑尾炎治疗术是一种安全有效地治疗急性非复杂性阑尾炎的内镜治疗方法,可有效缩短患者的手术时间、住院时间和降低并发症发生率,具有临床推广及应用价值。     

内镜下逆行阑尾炎治疗术对急性非复杂性阑尾炎的效果分析

目的:观察内镜下逆行阑尾炎治疗术( ERAT )治疗急性非复杂性阑尾炎的效果。 方法:选取福建省三明市尤溪县总医院 2020 年 1 月至 2022 年 12 月收治的急性非复杂性阑尾炎患者 120 例,按照随机数字表法分为对照组和研究组,各 60 例。对照组行腹腔镜阑尾切除术( LA )治疗,研究组行 ERAT 治疗。记录两组手术及术后相关指标、并发症发生情况及手术前后血清致炎因子 [ 白细胞介素 -6 ( IL-6 )、 C 反应蛋白( CRP )、降钙素原( PCT )、肿瘤坏死因子 -α( TNF-α ) ] 、疼痛介质 [ 多巴胺( DA )、 P 物质( SP )、 5- 羟色胺( 5-HT )、前列腺素 E 2 ( PGE 2 ) ] 水平。 结果:研究组手术及术后相关指标均优于对照组( P<0.05 );研究组术后 24 h 、 48 h 血清 IL-6 、 CRP 、 PCT 、 TNF-α 、 DA 、 SP 、 5-HT 、 PGE 2 水平较对照组低( P<0.05 );研究组并发症总发生率( 1.67% )较对照组( 6.67% )略低,但差异无统计学意义( P>0.05 )。 结论:采用 ERAT 治疗急性非复杂性阑尾炎可有效降低患 者 术 后 血 清 致 炎 因 子 、疼 痛 介 质 水 平 ,促 进 术 后 恢 复 ,且 手 术 安全性良好。     

内镜下逆行阑尾炎治疗术、腹腔镜阑尾切除术治疗急性阑尾炎脓肿患者的效果及对机体免疫功能的影响

目的 对比内镜下逆行阑尾炎治疗术(ERAT)、腹腔镜阑尾切除术(LA)治疗急性阑尾炎(AA)脓肿患者的效果及对机体免疫功能的影响。方法 回顾性分析2021年5月至2023年5月该院收治的80例AA脓肿患者的病历资料,按手术方案不同分A组和B组,每组40例。A组接受ERAT治疗,B组接受LA治疗。对比两组恢复指标水平(包括体温复常时间、下床活动时间、手术时间、胃肠功能恢复时间、术中失血量)、术前及术后1 d视觉模拟评分法(VAS)评分、胃肠激素[胃泌素(GAS)、血管活性肠肽(VIP)、胃动素(MTL)]、免疫功能(CD3⁺ T淋巴细胞比例、CD4⁺ T淋巴细胞比例、CD4⁺/CD8⁺比值)水平,以及并发症发生率。结果 A组体温复常时间、下床活动时间、手术时间、胃肠功能恢复时间均短于B组,术中失血量少于B组,差异均有统计学意义(P<0.05);A组术后1 d VAS评分低于B组(P<0.05);A组术后1 d血清GAS、MTL水平高于B组,血清VIP水平低于B组,差异均有统计学意义(P&l...     

超声造影在内镜治疗小儿非复杂性阑尾炎中的应用

目的 探讨超声造影(CEUS)在内镜治疗小儿非复杂性阑尾炎中的应用价值。方法 回顾性分析65例经内镜治疗的非复杂性阑尾炎患儿临床及超声资料。总结CEUS的图像特征及诊断价值。结果 (1)60例患儿插管成功,常规二维超声和CEUS检查阑尾显示率分别为40%(24/60)、75%(45/60)。(2)CEUS表现为39例出现阑尾形态的改变,包括阑尾外形卷曲、走行迂曲,阑尾僵直或固定,内壁毛糙或不光滑,管径增宽及内腔狭窄;32例造影显示明显或局部充盈缺损,提示粪石形成或粪渣沉积;所有患儿均未出现造影剂外漏。(3)治疗后阑尾管径、阑尾内腔及腔内充盈缺损情况较治疗前改善(P<0.01)。结论 CEUS观察小儿非复杂性阑尾炎具有一定声像图特征,可用于内镜逆行阑尾炎治疗术的疗效评价。     

大肠镜下治疗粪石梗阻性阑尾炎的研究

目的 探讨大肠镜下治疗粪石梗阻性阑尾炎的效用性、安全性.方法 选择下腹部阑尾区彩色多普勒检查证实为粪石梗阻性阑尾炎患者23例,实施经大肠镜逆行插管阑尾造影,并在内镜下将粪石取出.追踪观察患者的临床症状,并比较粪石取出前、后的免疫指标的变化.结果 所有患者阑尾内粪石均顺利取出,临床症状消失,无严重并发症.免疫指标治疗前、后差异无显著性.随访3～18个月除1例失访外,所有患者均无复发.结论 内镜下治疗粪石梗阻性阑尾炎是安全、有效的,为保留器官完整性治疗阑尾炎提供良好的治疗途径.     

内镜逆行阑尾炎治疗术治疗急性非穿孔性阑尾炎的临床疗效及其对血清炎症因子的影响

[目的]探讨内镜逆行阑尾炎治疗术(ERAT)治疗急性非穿孔性阑尾炎的临床疗效及对血清炎症因子水平的影响.[方法]选取2015年1月至2016年6月本院普外科收治的82例急性非穿孔性阑尾炎患者作为研究对象,将其随机分为ERAT组和腹腔镜阑尾切除术组(LA组),每组各41例.比较两组手术情况、并发症情况及血清白介素(IL)-6、C反应蛋白(CRP)、α-肿瘤坏死因子(TNF-α)、降钙素原(PCT)水平变化.[结果]ERTA组的手术时间、术后卧床时间、体温复常时间、住院时间均短于LA组,差异均具有统计学意义(均P<0.05).术后24 h两组血清IL-6、CRP、TNF-α、PCT水平均显著高于术前1 h,但ERAT组血清IL-6、CRP、TNF-α、PCT水平显著低于LA组,差异具有统计学意义(P<0.05);术后72 h两组血清IL-6、CRP、TNF-α、PCT水平均较术后24 h显著降低,ERAT组显著低于LA组,差异具有统计学意义(P<0.05).ERAT组术后1例消化道出血,其术后并发症发生率为2.44%(1/41);LA组1例腹腔脓肿,1例切口感染,1例肠梗阻,并发症发生率为7.32%(3/41),两组并发症发生率比较,差异无统计学意义(P>0.05).[结论]ERAT治疗急性非穿孔性阑尾炎安全有效,能够保留阑尾结构完整性,有利于减轻创伤应激反应、促进术后恢复.     

内镜下逆行阑尾炎治疗术治疗急性阑尾炎疗效的Meta分析

目的 评估内镜下逆行阑尾炎治疗术（ERAT）在急性阑尾炎治疗中的疗效。方法 通过计算机检索CNKI数据库、万方数据库、PubMed和谷歌学术中2017年－2020年ERAT治疗急性阑尾炎的相关文献,采用Review Manager 5.3.5统计软件进行数据处理,对纳入资料的异质性进行分析,计算OR＾值及95%CI。结果 按照入选标准,共纳入33项临床试验,2 729例患者。Meta分析结果显示：ERAT组住院时间和手术时间明显较传统手术组短（MD = -2.81,95%CI：-3.28～-2.34;MD = -20.24,95% CI：-22.63～-17.85）,总并发症发生率明显较传统手术组低（OR＾ = 0.19,95%CI：0.13～0.26）,体温恢复明显较传统手术组快（MD = -1.03,95%CI：-1.41～-0.65）。结论 ERAT是一种安全有效地治疗急性阑尾炎的方法,可缩短手术时间和住院时间,降低并发症发生率,具有临床推广价值。     

Endoscopic treatment for acute appendicitis with coexistent acute pancreatitis: Two case reports

BACKGROUNDAppendectomy is the procedure of choice for the treatment of acute appendicitis. However, surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis (AP). Endoscopic retrograde appendicitis treatment (ERAT) may be a novel alternative to surgery for treating such patients where existing medical therapies have failed.CASE SUMMARYWe report 2 cases of moderately severe AP who developed acute uncomplicated appendicitis during their hospital stay and did not respond to traditional medical therapy. One patient had moderately severe AP due to hyperlipidemia, while the other patient had a gallstone induced by moderately severe AP. Neither patient was fit to undergo an appendectomy procedure because of the concurrent AP. Therefore, the alternative and minimally invasive ERAT was considered. After written informed consent was collected from the patients, the ERAT procedure was performed. Both patients exhibited fast postoperative recovery after ERAT with minimal surgical trauma.CONCLUSIONERAT is a safe and effective minimally invasive endoscopic procedure for acute appendicitis in patients with coexistent AP.     

Is endoscopic retrograde appendicitis therapy a better modality for acute uncomplicated appendicitis? A systematic review and meta-analysis

BACKGROUNDPrevious studies had shown endoscopic retrograde appendicitis therapy (ERAT) is an effective treatment for acute appendicitis. However, different studies reported conflicting outcomes regarding the effectiveness of ERAT in comparison with laparoscopic appendectomy (LA).AIMTo compare the effectiveness of ERAT with LA. METHODSRandomized controlled trials (RCTs) and retrospective studies of ERAT for acute uncomplicated appendicitis were searched in PubMed, Cochrane Library, Web of Science, Embase database, China National Knowledge Infrastructure (CNKI), the WanFang Database, and Chinese Scientific Journals Database (VIP) from the establishment date to March 1 2021. Heterogeneity was assessed using the I-squared statistic. Pooled odds ratios (OR), weighted mean difference (WMD), and standard mean difference (SMD), with 95% confidence intervals (CI) were calculated through either fixed-effects or random-effects model. Sensitivity analysis was also performed. Publication bias was tested by Egger''s test, and Begg’s test. The quality of included RCT were evaluated by the Jadad scale, while Newcastle-Ottawa scale is adopted for assessing the methodological quality of case-control studies. All statistical analysis was performed using Stata 15.1 statistical software. All statistical analysis was performed using Stata 15.1 statistical software. This study is registered with PROSPERO, CRD42021243955. RESULTSAfter screening, 10 RCTs and 2 case-control studies were included in the current systematic review. Firstly, the length of hospitalizations [WMD = -1.15, 95%CI: -1.99, -0.31; P = 0.007] was shorter than LA group. Secondly, the level of post-operative CRP [WMD = -10.06, 95%CI: (-17.39, -2.73); P = 0.007], TNF-α [WMD = -7.70, 95%CI: (-8.47, -6.93); P < 0.001], and IL-6 Levels [WMD = -9.78, 95%CI: (-10.69, -8.88); P < 0.001; P < 0.001] in ERAT group was significantly lower than LA group. Thirdly, ERAT group had a lower incidence of intestinal obstruction than LA group. [OR = 0.19, 95%CI: (0.05, 0.79); P = 0.020]. Moreover, the quality of 10 RCTs were low with 0-3 Jadad scores, while the methodological quality of two case-control studies were fair with a score of 2 (each). CONCLUSIONCompared with LA, ERAT reduces operation time, the level of postoperative inflammation, and results in fewer complications and shorter recovery time, with preserving the appendix and its immune and biological functions.     

Single-port laparoscopic appendectomy using a needle-type grasping forceps compared with conventional three-port laparoscopic appendectomy for patients with acute uncomplicated appendicitis: a single-center retrospective study

ObjectiveTo compare the clinical outcomes between single-port laparoscopic appendectomy using a needle-type grasping forceps (SLAN) and conventional three-port laparoscopic appendectomy (CLA) for patients with uncomplicated appendicitis.MethodsWe retrospectively collected clinical data of patients with uncomplicated appendicitis who underwent SLAN or CLA from May 2019 to May 2021 in our center. The patients’ baseline characteristics, perioperative outcomes, and follow-up data were compared between the two groups. Additionally, baseline characteristics were compared with postoperative outcomes in the SLAN group.ResultsNinety-six patients were enrolled (SLAN group, n = 32; CLA group, n = 64). The SLAN group had a shorter hospital stay, lower 24-hour postoperative visual analogue scale scores, shorter postoperative fasting time, lower frequency of antibiotic administration, and longer operative time than the CLA group. In the SLAN group, younger patients had a longer appendix and male patients had a thicker appendix; additionally, patients with an appendiceal diameter of 0.6 to 1.0 cm had a longer postoperative hospital stay and higher frequency of antibiotic administration.ConclusionsCompared with CLA, SLAN may be less invasive, provide faster postoperative recovery, and result in better cosmesis for patients with uncomplicated appendicitis. Further research should be performed to evaluate the long-term outcomes.     

急性化脓性阑尾炎行腹腔镜手术与开腹手术的比较

目的探讨急性化脓性阑尾炎行腹腔镜阑尾切除术(LA)的可行性及疗效。方法对2009年5月至2010年12月收治的125例急性化脓性阑尾炎(术后病检证实为急性蜂窝织炎性阑尾炎)患者,其中56例行LA术,69例开腹阑尾切除术(OA),对LA和OA治疗化脓性阑尾炎的疗效方面进行回顾性综合分析。结果 LA组与OA组在手术操作时间上差异无统计学意义;LA组在切除阑尾的同时可以发现和治疗其他隐性疾病,OA组则无此作用;LA组均未放置引流管;而OA组有42例放置引流管、在术后使用镇痛药、术后下床活动时间、切口感染发生率、住院时间等项中,LA组明显优于OA组;平均住院费用LA组稍高于OA组。结论 LA术后恢复快,创伤小兼有美容效果,不污染手术切口,切口并发症少,是目前阑尾切除术较理想的方法,值得推广。     

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。     

小儿腹腔镜阑尾切除与传统阑尾切除术的对比研究

目的对比研究腹腔镜阑尾切除术(LA)与传统阑尾切除术(OA)治疗小儿阑尾炎的优缺点。方法回顾分析该院2009年1月至2011年10月89例小儿阑尾炎手术的临床资料,其中LA 36例,OA 53例,比较两种手术方式在手术时间、术后下床活动时间、肛门排气时间、并发症发生例数、住院时间、患方满意度等方面的差异性。结果 LA组与OA组手术时间比较,差异无统计学意义(P>0.05),术后下床时间、肛门排气时间、并发症发生例数、住院时间、患方满意度等方面LA组优于OA组,差异有统计学意义(P<0.05)。结论腹腔镜阑尾切除术具微创、并发症少、恢复快的优势,提倡将其用于小儿阑尾炎治疗。     

儿童急性阑尾炎的超声诊断

目的探讨超声检查在儿童急性阑尾炎诊断中的应用价值。方法对246例临床疑为急性阑尾炎的患儿予以急诊腹部B超检查。通过测量阑尾外径,观察阑尾腔内容物,阑尾壁有无充血,以及阑尾周围情况等来判断是否存在阑尾炎。结果246例急性腹痛患儿中,114例超声诊断为急性阑尾炎,其中97例急诊手术切除阑尾,另17例阑尾脓肿予非手术治疗,于6个月后择期手术。术后病理均证实诊断无误。余132例患儿中121例肠系膜淋巴结炎,6例卵巢囊肿,1例胆总管囊肿,1例肠系膜囊肿,2例右肾积水,1例右侧输尿管结石。肠系膜淋巴结炎患儿予非手术治疗,其中103例好转,18例因症状不消失仍施以阑尾切除术,病理报告5例为化脓性阑尾炎,13例为单纯性阑尾炎。结论超声检查在儿童急性阑尾炎的诊断中有实用价值。     

Receiver operating characteristic analysis of leukocyte counts in operations for suspected appendicitis

Study Objective

There has been no clear-cut value of the white blood cell (WBC) count in differential diagnosis of acute appendicitis in emergency medicine. Therefore, the aim of this study was to assess the preoperative WBC counts in 3 groups of patients operated on for a clinical suspicion of acute appendicitis with different findings at appendectomy: uninflamed appendix, uncomplicated acute appendicitis, or complicated acute appendicitis.

Methods

The medical records of 540 patients who underwent appendectomy for suspected acute appendicitis during a 17-month period were retrospectively reviewed. Data for 3 groups of patients were analyzed to calculate the sensitivity and specificity of the WBC count in the diagnosis of acute appendicitis, and we calculated likelihood ratios for 2 cut-points with either high sensitivity or high specificity. Receiver operating characteristic curves were used to evaluate the WBC count in relation to the true diagnosis and severity of acute appendicitis.

Results

We were able to identify patients with appendicitis on a statistically significant level using receiver operating characteristic curves of WBC counts (area under the curve = 0.756, P < .001), but the WBC count had no diagnostic value in differentiating between uncomplicated and complicated groups (area under the curve =0.55, P = .086). Likelihood ratio ranged from 1.79 (95% confidence interval, 1.17-2.3) for WBC count of more than 10 500 cells/mm³ to 3.20 (95% confidence interval, 2.72-3.24) for WBC count of more than 14 300 cells/mm³.

Conclusion

White blood cell count is helpful in the diagnosis and exclusion of appendicitis. However, there is no value to differentiate advanced appendicitis.