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安全性评估*

目的研究内镜下逆行阑尾炎治疗术(ERAT)治疗急性非复杂性阑尾炎的疗效及安全性。方法将急性非复杂性阑尾炎患者纳入研究,根据治疗方法不同分为内镜下逆行阑尾炎治疗术(ERAT)组和腹腔镜阑尾切除术(LA)组,比较两组患者的治疗情况、并发症及随访情况。结果 ERAT组患者均顺利完成内镜手术,无1例转外科手术治疗。LA组有1例患者转开腹阑尾切除术。ERAT组平均手术时间为(49.7±18.2)min,明显低于LA组(68.9±25.9)min,P0.05。ERAT组术后体温恢复正常时间(1.3±0.5)d,白细胞恢复正常时间(2.0±0.9)d,卧床时间(0.1±0.2)d,平均住院日(3.3±1.6)d均明显低于LA组(P0.05)。ERAT组中有14例患者伴有阑尾粪石(7例块状粪石,4例碎渣样粪石,3例碎渣样粪石伴阑尾腔狭窄),均以取石球囊或网篮成功取出,取石成功率100.00%。ERAT组并发穿孔1例,经保守治疗痊愈。ERAT术后随访至少半年,阑尾炎复发率为10.00%,1例于ERAT后5个月行LA,随访期间的外科手术率5.00%。结论 ERAT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,具有创伤小、恢复快等优点。特别是伴有粪石、阑尾腔狭窄的急性非复杂性阑尾炎患者,应作为ERAT的最佳适应证。

Effect and safety of Endoscopic retrograde appendicitis therapy in treating patients with uncomplicated acute appendicitis*

Objective To study the effect and safety of endoscopic retrograde appendicitis therapy (ERAT) in treating patients with uncomplicated acute appendicitis. Methods Patients with uncomplicated acute appendicitis were enrolled and divided into ERAT group and LA group received laparoscopic appendectomy. Then compare treatment condition, complications and follow-up of the two groups. Results ERAT were completed successfully in all the patients in ERAT group, while one patient underwent a reversion to open appendectomy for technical difficulties in LA group. Mean operative time was (49.7 ± 18.2) min for ERAT group and (68.9 ± 25.9) min for LA group (P < 0.05). Fever relief time (1.3 ± 0.5) d, WBC normalization time (2.0 ± 0.9) d, mean bed time (0.1 ± 0.2) d and mean hospital stay (3.3 ± 1.6) d for ERAT group were significantly lower than LA group (P < 0.05). 14 patients with intraluminal appendicoliths (7 of massive appendicoliths, 4 of broken appendicoliths and 3 of broken appendicoliths with luminal stenosis) underwent endoscopic lithotomy successfully in ERAT group, resulting in a success rate of 100.00%. One patient presented perforation after ERAT was cured with conservative treatment. During the follow-up of at least 1/2 year, the rate of recurrence was 10.00% in ERAT group. 1 patient (5.00%) underwent LA at the 5th month after ERAT during the follow-up. Conclusion ERAT is an effective and safe therapy in treating patients with uncomplicated acute appendicitis with advantages of minimal invasiveness and quick recovery. Uncomplicated acute appendicitis with appendicoliths and/or luminal stenosis are the most suitable indications for ERAT.