微波照射预防阑尾炎术后患儿切口感染20例临床观察

目的研究微波照射预防阑尾炎术后切口感染的临床效果。方法采用回顾性分析的方法,分析了2013年8月3日至2013年11月31日间收治的40例行阑尾炎手术患儿的临床资料,根据术后处理方法不同,将患儿随机分为对照组和治疗组各20例,其中对照组行常规术后处理,治疗组在对照组治疗的基础上实施微波照射,观察分析2组患儿术后切12发生感染的情况、切口愈合的平均时间及治疗情况。结果治疗组总有效率100．0％,对照组为75．0％,2组比较差异有统计意义（P〈0．05）。治疗组切口平均愈合时间为（15．24±2．34）h,患儿感觉良好,切口周围有温热感,止痛、消肿、消炎效果明显,未发生烫伤,无切口感染等并发症发生;对照组切口平均愈合时间为（21．33±2．58）h,有4例（20．0％）患儿出现切口感染,经积极治疗后,症状得以缓解。2组平均愈合时间及切口感染率比较,差异有统计意义（P〈0．05）。结论微波照射可以有效预防阑尾炎术后切口感染,具有良好的临床疗效,值得在临床上推广应用;在微波照射治疗过程中需加强护理,防止烫伤。     

基层医院隐瘢痕腹腔镜阑尾切除术临床应用

目的：探讨隐瘢痕腹腔镜阑尾切除术在基层医院的应用。方法90例急性阑尾炎患者行隐瘢痕腹腔镜阑尾切除术的临床资料。结果90例患者手术均获得成功,均治愈出院。腹壁瘢痕隐蔽且不明显,疗效满意。结论隐瘢痕腹腔镜阑尾切除术,创伤小,恢复快,术后瘢痕隐秘,美容效果好,且无需特殊器械,适合基层医院应用。     

比较CT和B超在诊断和鉴别诊断急性阑尾炎中的价值

目的：比较CT和B超在诊断和鉴别诊断急性阑尾炎中的临床价值。方法选取本院收治的46例急性阑尾炎患者,术前均分别使用CT和B超进行检查,以病理检查结果为金标准,比较两种检查方法诊断符合率的差异。结果46例患者中CT诊断为阑尾增粗或是阑尾炎可疑的患者29例,诊断为阑尾周围脓肿的患者14例,诊断符合率为93.5％,显著高于B超的80.4％（ P＜0.05）。结论 CT诊断急性阑尾炎的灵敏性及可靠性均显著优于 B超,可作为首选辅助检查方法。     

小切口及术中硫酸奈替米星局部治疗急性化脓性阑尾炎合并腹膜炎临床分析

目的：探讨小切口加硫酸奈替米星局部治疗化脓性阑尾炎合并腹膜炎的疗效。方法以224例化脓性阑尾炎者为此次的探究主体,随机将其分组。观察组接受的术式是小切口,同时应用硫酸奈替米星。对照组则选用传统的术式。结果在所需的手术时间以及切口长度等指标方面进行比较,观察组手术情况要好于对照组。随访术后切口的恢复,发现观察组效果明显较好。其中观察组切口出现脂肪液化现象的仅有3例,其他皆完全恢复。而对照组有12例患者出现了脂肪液化现象。其余有4例发生腹腔感染,切口疝3例。P〈0.01,两组间的差异存在统计学意义。结论小切口的术式可以较好的治疗合并有腹膜炎的阑尾炎者,同时使用硫酸奈替米星可以进一步的提高治疗。     

微创手术用于急性阑尾炎的疗效研究

目的：对临床常用的微创及开腹手术在急性阑尾炎治疗中的疗效及安全性进行比较。方法：选取本院2010年3月-2012年3月两年间采用手术治疗的急性阑尾炎患者94例为研究对象,将其随机分为两组,每组47例。对照组使用传统的开腹手术进行治疗;观察组使用腹腔镜微创手术治疗。比较两组的临床疗效、术中数据及安全性。结果：观察组的有效率为89.4%,对照组为91.5%,差异无统计学意义（P〉0.05）;观察组在安全性、手术创口、术中出血量、并发症及患者的治疗依从性方面均优于对照组,差异具有统计学意义（P〈0.05）。结论：微创手术在急性阑尾炎的治疗中具有有效率高、安全性高、治疗依从性高等优势,具有重要的临床价值。     

Schistosomiasis as a rare cause of recurrent acute appendicitis – A case report

INTRODUCTION

We are presenting a case of schistosomiasis in a 41 year old lady who presented with right iliac fossa pain for 3 years. The pain worsened and the frequency increased in the last 3 months prior to referral. The ultrasound was unremarkable. Her bowel habits were normal and there was no vomiting. There was no blood in the stool or in the urine.

PRESENTATION OF CASE

The abdomen was soft except on deep palpation. There was slight tenderness in the right lower quadrant. A repeat ultrasound was unremarkable. The full blood count was within the normal range. A diagnosis of recurrent acute appendicitis was made and an interval appendicectomy was performed.

DISCUSSION

Histopathology results revealed schistosomiasis of the appendix. There was no acute inflammation but there was fibrous obliteration of the distal lumen of the appendix and reactive lymphoid hyperplasia.

CONCLUSION

This is the first case in a country with relatively clean drinking water. There are no irrigation schemes but there are seasonal rivers and streams. The patient admits to swimming in these streams during childhood. Clinical features of schistosomiasis were not elicited.     

An unusual presentation of perforated appendicitis in epigastric region

INTRODUCTION

Atypical presentations of appendix have been reported including backache, left lower quadrant pain and groin pain from a strangulated femoral hernia containing the appendix. We report a case presenting an epigastric pain that was diagnosed after computed tomography as a perforated appendicitis on intestinal malrotation.

PRESENTATION OF CASE

A 27-year-old man was admitted with a three-day history of epigastric pain. Physical examination revealed tenderness and defense on palpation of epigastric region. There was a left subcostal incision with the history of diaphragmatic hernia repair when the patient was 3 days old. He had an intestinal malrotation with the cecum fixed at the epigastric region and the inflamed appendix extending beside the left lobe of liver.

DISCUSSION

While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality.

CONCLUSION

Atypical presentations of acute appendicitis should be kept in mind in patients with abdominal pain in emergency room especially in patients with previous childhood operation for diaphragmatic hernia.     

Double anterior (anterolateral and anteromedial) thigh flap for oral perforated defect reconstruction

ObjectiveThe purpose of this study was to assess the therapeutic efficacy of oral perforated defect reconstruction with a double anterior (anterolateral and anteromedial) thigh flap through the modified lateral lip-submandibular approach.Materials and methodsFrom July 2010 to August 2013, eight patients with oral perforated defects secondary to oral cancer ablation involving the superior partial mandible or the posterior partial maxilla, with immediate reconstruction by double anterior (anterolateral and anteromedial) thigh flaps, were retrospectively enrolled into this study.ResultsAll double anterior flaps were musculocutaneous flaps. Seven double flaps resulted in good functional and aesthetic outcomes with complete flap survival. One patient required operative exploration in the postoperative period due to thrombosis in the external jugular vein. After the salvage, one of the double flaps in the intraoral region resulted in partial failure of the superficial skin of the flap. No functional impairment at the donor sites occurred in any of the cases.ConclusionThe double anterior (anterolateral and anteromedial) thigh flap is a feasible and acceptable technique for reconstruction of an oral perforated defect involving the mandible or the maxilla through the modified lateral lip-submandibular approach. It presents a very acceptable aesthetic and functional result with the additional advantage of low morbidity at the donor site.     

阑尾炎罕见并发症--阑尾膀胱瘘

目的探讨阑尾膀胱瘘形成的原因和影像学检查在阑尾膀胱瘘中的诊断价值。方法回顾性分析本院1例阑尾膀胱瘘患者的诊断资料,并复习其他相关文献。结果此例阑尾膀胱瘘形成的原因是阑尾巨大结石并炎症反复发作,致阑尾与膀胱长期粘连,导致破溃、融合,形成内瘘,仅靠多层螺旋CT检查尚无法完全确诊,要结合腹腔镜探查进行确诊。结论单一检查确诊率较低,多层螺旋CT检查在阑尾膀胱瘘中的诊断价值较高,结合腹腔镜探查才能确诊,其他影像学检查也能起到一定的辅助诊断作用。