以肠梗阻为表现的急性阑尾炎合并穿孔43傻诊治体会

目的分析总结以肠梗阻为表现的急性阑尾炎合并穿孔的临床特征，减少因误诊给患者带来更多后遗症，以提高临床治疗水平。方法回顾性分析本院2006～2011年以急性肠梗阻收入院后证实为急性阑尾炎合并穿孔患者的临床资料。结果7例因肠梗阻症状严重入院后即行急诊剖腹探查手术。36例梗阻症状较轻先予胃肠减压抗炎等处理后行手术治疗，43例均已治愈。结论本组患者误诊率较高，由于发病开始临床表现不典型，之后出现的肠梗阻症状又掩盖了原发病（阑尾炎）的临床表现，所以鉴别诊断显得尤为重要，B超及CT等辅助检查在以肠梗阻为表现的急性阑尾炎合并穿孔的诊断有较高价值，手术是诊断和治疗以肠梗阻为主要表现的阑尾炎穿孔的最好方法。

Experience in diagnosis and treatment of acute appendicitis manifested as intestinal obstruction with the combination of perforation in 43 cases

Objective To analyze and summarize the clinical characteristics of acute appendicitis manifested as intestinal obstruction with the combination of perforation, and reduce so many sequelae due to misdiagnosis in order to improve the level of clinical treatment. Methods The clinical data of patients with acute intestinal obstruction admitted into our hospital and later proved to be acute appendicitis combining with perforation from 2006 to 2011 were retro- spectively analyzed. Results Seven cases presented with severe intestinal obstruction were operated with exploratory laparotomy after admission into the hospital. The rest 36 cases due to the mild intestinal obstruction were first dealt with gastrointestinal decompression and anti-inflammatory, and then treated by operation. All cases were cured. Conclusion The misdiagnosis rate in the group is higher due to atypical clinical manifestations in clinic when onset and intestinal obstruction covering the symptoms of primary disease. Therefore, identification and diagnosis become very important. Auxiliary examinations like B ultrasound, computed tomography take high positions in the diagnosis of acute appendicitis manifested as intestinal obstruction on the complication of perforation, to which the best way is surgery for its diagnosis and treatment.