自制圈套器在腹腔下阑尾切除术中的临床应用

目的 探讨自制圈套器在腹腔镜下阑尾切除术中临床应用的可行性。方法 回顾性分析本院胃肠外科2015 年6 月~2017 年6 月收治的行腹腔镜下阑尾切除术患者的临床资料共197 例，其中自制圈套器组85 例，Hem-o-lok 组112 例。比较两组患者手术时间、术中出血量、术后首次肛门排气时间、住院时间的差异。比较两组患者切口感染、腹腔脓肿、肠梗阻发生率的差异。结果 两组患者的手术时间[自制圈套器组（43.71±5.54）min：Hem-o-lok 组（42.29±5.34）]min、术中出血量[自制圈套器组（11.60±2.44）mL：Hem-o-lok 组（11.00±2.56）mL]、术后首次肛门排气时间[自制圈套器组（10.01±2.27）h：Hem-o-lok 组（9.60±2.32）h]和住院时间[自制圈套器组（5.19±0.95）d：Hem-o-lok 组（4.99±0.85）d]相比，差异均无统计学意义（P>0.05）。两组患者切口感染[自制圈套器组2 例（2.35%）：Hem-o-lok 组3 例（2.68%）]、腹腔脓肿[自制圈套器组1 例（1.18%）：Hem-o-lok 组2 例（1.79%）]、肠梗阻[自制圈套器组3 例（3.53%）院Hem-o-lok 组5 例（4.46%）]的发生率相比，差异均无统计学意义（P>0.05）。结论 自制圈套器在腹腔镜下阑尾切除术中应用是安全可行的.     

RIPAS阑尾炎评分对可疑急性阑尾炎的诊断价值

目的:研究RIPAS阑尾炎(RIPASA)评分对可疑急性阑尾炎的诊断价值。方法:对2014年1月-2015年1月诊断的可疑急性阑尾炎患者150例分别以Alvarado评分和RIPASA评分进行评估,比较其诊断价值。结果:以7.5分和7分定义为RIPASA和Alvarado评分的最佳界值,RIPASA评分和Alvarado评分诊断急性阑尾炎的敏感度、特异度、阳性预测值、阴性预测值、准确率、阑尾阴性切除率分别为(97.50%、81.42%、85.71%、96.61%、90.30%、14.29%)和(68.75%、87.14%、85.93%、70.93%、73.80%、14.06%);使用RIPASA和Alvarado评分对可疑急性阑尾炎患者评估结果与综合临床诊断结果相关联,且RIPASA评分关联程度明显高于Alvarado评分(P0.05)。结论 :急诊医师使用RIPASA评分对中国大陆地区东方人种可疑急性阑尾炎患者进行辅助诊断优于Alvarado评分。     

椎管内麻醉与全身麻醉用于急性阑尾炎手术的临床抉择的探讨

目的：探讨急性阑尾炎手术的最佳麻醉方法。方法搜集2011年3月～2013年3月计划手术治疗的急性阑尾炎患者146例，并随机分为两组，其中A组73例术中采用椎管内麻醉，B组73例术中采用全身麻醉，分析比较两种麻醉方法用于急性阑尾炎手术的临床疗效。结果 A组患者手术的可控性及连续性要优于B组，但患者术后疗效及预后较B组差。结论掌握不同麻醉方法用于不同情况下的急性阑尾炎尤为重要。     

Incidence of appendicitis according to region of origin in first- and second-generation immigrants and adoptees in Sweden. A cohort follow-up study

Background. Geographic variations in incidence of appendicitis and proportion of perforations suggest environmental or genetic etiological factors. We study incidence of appendicitis and proportion of perforations according to geographical origin in immigrants and international adoptees in Sweden. Methods. A cohort of 11,557,566 Swedish residents – 277,104 first- and 377,773 second-generation immigrants and 57,304 adoptees – was followed from 1988 till 2010. Differences in proportion of operation for perforated appendicitis and negative appendectomy and standardized incidence ratios (SIR) of perforated and non-perforated appendicitis associated with geographic origin was analyzed. Results. High incidence rates are seen in first- and second-generation immigrants from South America for perforated (SIR 1.58 and 1.81, respectively) and non-perforated appendicitis (SIR 1.18 and 1.22, respectively), and in adoptees from South America for non-perforated appendicitis (SIR 1.07). Low incidence rates are seen for perforated appendicitis in first-generation immigrants and adoptees from Asia (SIR 0.74 and 0.56, respectively), and for non-perforated appendicitis in immigrants from Africa and Asia (SIR 0.69 and 0.76 in first-generation, 0.51 and 0.74 in second-generation, respectively) and in adoptees from Asia (SIR 0.71). A high proportion of perforated appendicitis is associated with a low incidence rate of non-perforated appendicitis but no increase in the incidence rate of perforated appendicitis. Conclusions. The association of different incidence of appendicitis with geographic origin which remains over generations and is seen in adoptees suggest genetic etiologic factors. The proportion of perforation can be high without an increased incidence rate of perforation and is therefore an imperfect indicator of quality of care.     

腹腔镜与开腹手术治疗急性阑尾炎的对比分析

目的对比分析腹腔镜与开腹手术治疗急性阑尾炎的疗效,总结其临床应用价值。方法选取我院2009年6月～2011年6月86例急性阑尾炎的患者,随机分为观察组(腹腔镜手术)和对照组(开腹手术)各43例,观察比较两组疗效。结果两组疗效比较差异显著(P<0.05),具有统计学意义。结论腹腔镜手术治疗急性阑尾炎效果显著,具有无创、恢复快、出血少等优点,安全可靠。     

超声对急性阑尾炎诊断的体会

目的：分析超声对急性阑尾炎诊断中的作用。方法：随机选取2011年11月～2013年11月在我院就诊的疑似急性阑尾炎患者122例,对这些患者进行超声检查,来确诊患者是否患有急性阑尾炎,同时根据其病灶形态,内部结构的异常病变,还有回声分布等同手术结果进行对比分析,判断患者所患阑尾炎的类型。结果：122例疑似急性阑尾炎病例中109例经超声检查为急性阑尾炎,手术后122例患者证实皆为急性阑尾炎,运用超声诊断阑尾炎结果相符率达89．3％。结论：超声检查能提高急性阑尾炎诊断的准确率,同时能根据其相关数据判断急性阑尾炎的类型,安全高效,值得在临床上推广。     

Delta neutrophil index and symptomatic time are effective factors for predicting perforated appendicitis

Appendicitis is a common intra-abdominal inflammatory disease, and morbidity increases with age when perforation occurs. Because, not all patients require emergency surgery, there have been numerous studies on factors for predicting perforated appendicitis. In this study, we aimed to confirm whether the delta neutrophil index (DNI) and the time from symptom onset to surgery are effective predictors for perforated appendicitis in different age groups.This was a retrospective study conducted on 542 appendicitis patients who underwent surgery at Kangdong Sacred Heart Hospital. The simple group consisted of 431 subjects, and the perforation group consisted of 111 subjects.Multiple logistic regression analyses demonstrated that age, neutrophil percentage, DNI, C-reactive protein (CRP), and symptomatic time were significant predictors of perforation. Analysis of the receiver-operating characteristic curve showed that the DNI was the most reliable predictive value. In the analyses according to age, the perforation rate was higher in the >65-year-age group; these patients also had a higher DNI, CRP, and symptomatic time. In the DNI analysis using receiver operating characteristic (ROC) analysis, the area under the curve was higher in the >65-year-age group than in other age groups. In addition, the cutoff values have been determined and perforation occurred significantly in the group with a DNI value of 2.1 or higher and a symptomatic time of 33 hours or longer.DNI is effective in predicting perforation in patients with appendicitis compared with other inflammatory factors. Furthermore, the simultaneous measurement of symptomatic time and DNI is helpful in predicting perforation and determining whether emergency surgery is necessary.