阑尾手术扩大回盲部切除44例临床分析

Investigation of indications of ileocecectomy in surgical management of appendicle diseases

目的:探讨阑尾手术扩大回盲部切除术的指征,为临床外科提供治疗经验。方法:回顾性研究1999～2008年在不同情况下1期施行的阑尾疾病扩大性回盲部切除术共44例,对其术中情况、手术方法、病理类型、疗效进行分析,与同期手术治疗的78例复杂性阑尾切除术进行比较。结果:44例1期施行的回盲部切除术患者均在术后2周内痊愈出院,手术并发症发生率为6.81%。而对照组因肠梗阻、腹腔残余脓肿、肠瘘、回盲部或阑尾肿块而行2次手术者达18例,并发症发生率为23.08%,明显高于回盲部切除术组(P<0.01)。结论:阑尾疾病合并小肠梗阻、盲肠壁裂口、阑尾或回盲部性质不明肿块等是施行回盲部切除术的主要指征,可明显减少术后并发症。

Objective：To determine indications of ileocecectomy in the surglcat management of appendicle diseases and find evidence for clinical treatment. Methods： Data of 122 patients with appendicle diseases who underwent operative surgery from 1999 to 2008 were studied retrospectively, including 44 cases of phase I ileocectomy due to appendicle diseases of non-appendicitis （Group A）and 78 cases of appendectomy due to complex appendicitis（ Group B ）. Surgical approaches, findings in surgery, pathology and effects of treatment of them were analyzed and compared. Results： Forty-four patients of group A who underwent phase I ileocectomy were cured with 6.81% complications and discharged in 14 days. Of the patients in group B, 18 cases underwent re-operation due to intestinal obstruction, abdominal abscess, fistula, appendicle or ileocecal lumps, the incidence of complications was 23.08%. Compared the two groups for complication, there was significant difference （P 〈 0.01 ）. Conclusion： Ileocecectomy indicates predominantly to patients with inconclusive serious appendicle diseases and/or ordinary appendicle diseases coexisted with intestinal obstruction, cecal wall fissure, appendicle or ileocecal lump, with advantage of significantly lower complications.