盲肠局部坏疽的诊断和治疗

The diagnosis and treatment of isolated cecal necrosis

目的探讨盲肠局部坏疽的诊断和治疗策略。方法对收治的12例盲肠局部坏疽的病因、诊断、治疗和预后等临床资料进行回顾性分析。结果 12例中男7例,女5例;平均年龄68.1岁。9例伴糖尿病,7例伴冠心病,11例伴高血压。临床表现为转移性或持续性右下腹痛及右下腹部腹膜刺激征。8例诊断为急性阑尾炎,4例为腹痛待查。均行手术治疗,术中见部分盲肠坏疽,病变直径2～4cm(平均2.7cm),所有患者经探查明确病灶后行回盲部切除。2例术后切口感染,皆经治疗后顺利康复出院。术后随访8～87个月(平均为56.7个月),其中的7位患者死于心肌梗塞,手术距死亡时间为10～36个月(平均16.3个月),其余5位患者存活至今。结论盲肠坏疽是罕见的疾病,诊断困难,必要时应用诊断性腹腔镜探查以及时明确诊断。治疗上应根据具体情况决定是否手术治疗。该病的发生似乎与心肌梗塞有关。

Objective To study the dignosis and treatment of isolated cecal necrosis.Methods The aetiology,diagnosis,treatment and outcome of 12 cases of isolated cecal necrosis were analysed retrospecively.Results Among the 12 cases,7 were male and 5 female.The average age was 68.1 years 9 cases had diabetes,7 had coronary heart disease and 11 had hypertension.The clinical manifestations were shifting or persistent right lower abdominal pain and right lower abdominal peritoneal irritation.Eight cases were diagnosed preoperatively as acute appendicitis and 4 cases as abdominal pain of unknown origin.All of them underwent operation and their cecum was found to be partially gangrenous.The diameter of the lesion was 2-4 cm（average 2.7 cm）.Ileocecal resection was performed in all cases.All the patients were discharged without any complications except 2 cases had incisional wound infection.During a follow-up of 8-87 months（mean：56.7months）,7 patients died of myocardial infarction at 10-36months（mean：16.3months） after operation.The other 5 patients were alive.Conclusions Isolated cecal necrosis is rare and difficult to be diagnosed.Diagnostic laparoscopy could be applied,if necessary to clinch the diagnosis.Whether surgical treatment is needed or not,depends on the individual case.The pathogenesis of this disease may be related with myocardial infarction.