CAJ | 학술논문

目的探讨异位阑尾炎的临床表现、诊断要点及腹腔镜治疗的策略.方法对新疆医科大学第二附属医院2011年4月-2015年4月间收治的19例异位阑尾炎的临床资料进行回顾性分析,总结其临床表现、诊治、腹腔镜探查指征及腹腔镜阑尾切除术的技巧.所有患者均在气管插管全麻下行腹腔镜探查+腹腔镜阑尾切除术.结果 19例患者中,术前有16例经B超检查得到确诊,B超确诊率为92.63％;3例急性局限性腹膜炎患者术前误诊,分别为右侧肾结石、急性胆囊炎、右侧附件炎各1例;中转开腹手术2例,手术中转率为10.53％.术中出血5～ 20 mL,术后9h下床活动,12 h进全流质饮食;平均住院时间4d.戳孔处感染1例,全腹腔镜手术的并发症发病率为5.27％,术后随访12 ～18个月未发现其他远期并发症.结论异位阑尾炎无特异性的临床表现,易误诊.辅助检查中,超声检查是诊断异位阑尾炎的首选检查手段.腹腔镜探查术+腹腔镜阑尾切除术是急诊治疗异位阑尾炎的理想术式,值得临床推广.
목적 탐토이위란미염적림상표현、진단요점급복강경치료적책략.방법 대신강의과대학제이부속의원2011년4월-2015년4월간수치적19례이위란미염적림상자료진행회고성분석,총결기림상표현、진치、복강경탐사지정급복강경란미절제술적기교.소유환자균재기관삽관전마하행복강경탐사+복강경란미절제술.결과 19례환자중,술전유16례경B초검사득도학진,B초학진솔위92.63％;3례급성국한성복막염환자술전오진,분별위우측신결석、급성담낭염、우측부건염각1례;중전개복수술2례,수술중전솔위10.53％.술중출혈5～ 20 mL,술후9h하상활동,12 h진전류질음식;평균주원시간4d.착공처감염1례,전복강경수술적병발증발병솔위5.27％,술후수방12 ～18개월미발현기타원기병발증.결론 이위란미염무특이성적림상표현,역오진.보조검사중,초성검사시진단이위란미염적수선검사수단.복강경탐사술+복강경란미절제술시급진치료이위란미염적이상술식,치득림상추엄.
Objective To explore the clinical manifestations,diagnosed main points,laparoscopic trestment strategy of ectopic appendicitis.Methods The 19 clinical data of ectopic appendicitis,from April 2011 to April 2015 in our hosipital,were retrospective analysised,and we sum up the clinical manifestation,diagnosis and treatment,laparoscopic exploration indications and the technique of laparoscopic appendectomy.Laparoscopy exploration and laparoscopic appendectomy were made on all patients under general anesthesia by tracheal cannula.Results Of 19 patients,16 cases by ultrasonic examination get correct diagnosis before operation,of which the ultrasound diagnosis rate is 92.63％,3 limitations of acute peritonitis patients were preoperative misdiagno~s,they were the right kidney stones,acute cholecystitis and the right side of the annex inflammation;there were 2 patients converted to open operation,and the transfer rate is 10.53％.The blood loss of the operation is about 5-20 mL.They were ambulant after 9 hours,in full flow diet after 12 hours,and the average hospitalization time is 4 days.One patient,no other long-term complications were found postoperatively follow-up of 12 to 18 months,were poke holes in infection,and the complications of laparoscopic surgery is 5.27％.Conclusions Ectopic acute appendicitis has no specific clinical manifestation,and is easy to misdiagnosis.In the auxiliary examination,ultrasound is the first choice for the diagnosis of ectopic appendictis.Laparoscopy exploration and laparoscopic appendectomy are the ideal treatments of emergency treatment of ectopic appendicitis,and are worth of clinic application.