继发性阑尾炎的诊断和治疗(附66例报道)

Diagnosis and Treatment of Secondary Appendicitis(Report of 66 Cases)

目的总结不同致病因素下阑尾炎的临床特点,提出继发性阑尾炎的概念及诊断和处理对策。方法对2003年11月至2008年11月期间以急性阑尾炎为初步诊断收入哈尔滨医科大学附属第一医院普外科的660例阑尾炎患者的临床资料进行回顾性分析。原发性阑尾炎组594例,继发性阑尾炎组66例,比较2组在发热、恶心或呕吐、腹痛、腹胀、排便习惯与性状改变、右下腹压痛、腹膜刺激征、腹部包块及血WBC临床特点方面的差别。结果 660例阑尾炎患者术后阑尾病理均呈炎性改变。原发性阑尾炎中单纯细菌感染171例(25.91%),粪石堵塞阑尾腔386例(58.48%),阑尾腔狭窄33例(5.00%),阑尾畸形4例(0.61%)。继发性阑尾炎中结肠癌7例(1.06%),包括升结肠癌5例、横结肠癌2例,行结肠癌根治术;妇科疾病20例(3.03%),包括右侧卵巢囊肿蒂扭转7例(行卵巢囊肿+阑尾切除术)、右侧卵巢黄体破裂5例(行右侧卵巢+阑尾切除术);急性盆腔炎或盆腔脓肿4例(行阑尾切除+盆腔脓肿引流术);宫外孕破裂4例(行右侧卵巢、输卵管切除+阑尾切除术);疝9例(1.36%),均为右侧腹股沟斜疝,行疝修补+阑尾切除术;肠结核6例(0.91%),行单纯阑尾切除术4例、回盲部切除术1例、右半结肠切除术1例;寄生虫病24例(3.64%),均行单纯阑尾切除术。原发性阑尾炎与继发性阑尾炎在恶心或呕吐、腹痛、腹胀、排便习惯与性状改变、右下腹压痛、腹部包块及血WBC临床特点方面比较,差异均有统计学意义(P<0.05),而在发热及腹膜刺激征方面差异无统计学意义(P>0.05).结论许多疾病可以引起继发性阑尾炎;重视继发性阑尾炎诊治,可以减少或避免临床漏诊及误诊的发生。

Objective To present the concept and explore the diagnosis and treatment strategies of secondary appendicitis. To summarize the clinical features of secondary appendicitis caused by different related factors. Methods The clinical data of 660 patients with a presumptive diagnosis of acute appendicitis between November 2003 and November 2008 in The First Affiliated Hospital of Harbin Medical University were collected and analyzed retrospectively. Five hundred and ninety-four patients with primary appendicitis （primary appendicitis group）,and 66 patients with secondary appendicitis （secondary appendicitis group）. Clinical parameters such as fever,nausea or vomit,abdominal pain,abdominal distension,change of defecation habits or characters,tenderness in the right lower abdominal quadrant,acute abdomen,abdominal mass,and WBC were compared between two groups. ResultsBiopsies of appendectomy were taken in all and the results showed inflammation. The pathogenic factors and cases of primary appendicitis：bacterial infection in 171 cases （25.91%）,appendix cavity blocked by fecalith in 386 cases （58.48%）,appendix cavity stricture in 33 cases （5.00%）,and appendix deformity in 4 cases （0.61%）. Sixty-six patients resulted from secondary appendicitis：colon carcinoma in 7 cases （1.06%） receiving laparocolectomy including 5 ascending colon and 2 transverse colon; gynecological disease in 20 cases （3.03%）,7 cases of right ovarian cyst accompanying adnexal torsion receiving oophorocystectomy combining with appendectomy,5 right rupture of corpus luteum of ovary receiving right ovariectomy combining with appendectomy,4 acute pelvic inflammation and pelvic abscess receiving transvaginal drainage of pelvic abscess combining with appendectomy,4 extra-uterine pregnancy receiving right ovariectomy and salpingectomy combining with appendectomy; 9 cases （1.36%） of hernia,all to be right oblique hernia,receiving herniorrhaphy combining with appendectomy; Intestinal tuberculosis in 6 cases （0.91%）,4 cases receiving appendectomy,1 case for resection of ileocecum,and 1 case for right hemicolectomy; parasitic disease in 24 cases （3.64%）,all to receive appendectomy. There were significant differences in nausea or vomit,abdominal pain,abdominal distension,changes of defecation habit or character,tenderness in the right lower abdominal quadrant,abdominal mass,and WBC between two groups （P0.05）. There was no significant difference in fever or acute abdomen between two groups （P0.05）. Inclusions Appendicitis could be secondary to many diseases. We must attach importance to the diagnosis of secondary appendicitis so that to decrease or avoid the appearance of missed diagnosis and misdiagnosed in the clinical.