阑尾周围脓肿患者36例手术治疗临床分析

Clinical Analysis of Surgical Treatment of 36 Cases Patients with Periappendicitis Abscess

目的探讨阑尾周围脓肿Ⅰ期手术及Ⅱ期手术的临床治疗效果、应用价值和优缺点。方法对2006年9月至2010年9月手术治疗的36例阑尾周围脓肿Ⅰ期及Ⅱ期患者的病例资料进行回顾性分析。结果 36例阑尾周围脓肿患者,行Ⅰ期手术20例,其中9例行Ⅰ期阑尾切除术,11例行单纯脓肿引流术,术中及术后未发生肠梗阻及肠管损伤,4例术后发生切口感染,经伤口换药和抗生素治疗后愈合;16例行Ⅱ期手术,术中发现炎性粘连性团块致不全性肠梗阻4例,寻找阑尾过程中分离粘连,发生盲肠(或升结肠)肠管损伤2例,改行右半结肠切除术,8例行阑尾切除术,2例行单纯脓腔引流术,3例术后切口感染,经伤口换药和抗生素治疗治愈。Ⅰ期手术和Ⅱ期手术相比较,肠梗阻和肠管损伤发生率Ⅰ期手术组优于Ⅱ期手术组,差异有统计学意义(P<0.05);Ⅰ期手术和Ⅱ期手术术后切口感染发生率分别为20.00%和18.75%,二者差异无统计学意义(P>0.05)。结论阑尾周围脓肿采用Ⅰ期手术治疗在降低肠梗阻及肠管损伤的发生率等方面明显优于Ⅱ期手术。

Objective To explore the effect,value of application,advantages and disadvantages of stage I surgery and stage II surgery of periappendicitis abscess.Methods From Sep.2006 to Sep.2010,data of 36 patients underwent periappendicitis abscess surgery stage I and II were retrospectively analyzed.Results Totally 36 periappendicitis abscess patients,20 cases were treated by stage I surgery,9 of them were treated by stage I appendectomies,other 11 cases were treated by only abscess drainage,obstruction and dilated bowel injuries were not found in intraoperative and postoperative,postoperative 4 cases had incision infection and healing after wound and antibiotic treatment;16 cases were treated by stage II surgery,intraoperation found inflammatory adhesive mass caused incomplete obstruction 4 cases,in process of exploring for the appendix,separate adhesion,caecum bowel injuries 2cases,changed to the right-side colon resection,8 cases were treated by appendectomy,3 cases were treated by only abscess drainage,3 cases had postoperative incision infection and healed after wound dressing and antibiotic treatment.Compared stage I surgery with stage II surgery,incidence of obstruction and bowel injuries was significantly better than stage II surgery（P0.05）;Incidence of incision infection of stage I surgery and stage II surgery was 20% and 18.75%,there was no significant difference（P0.05）.Conclusion Using stage I surgery in treatment of periappendicitis abscess can reduce incidence of obstruction and bowel injuries better than stage II surgery.