肠镜下治疗急性阑尾炎的临床研究

Endoscopic treatment for acute appendicitis

目的 探讨结肠镜治疗急性阑尾炎（非穿孔性及坏疽性）的疗效.方法 将94例急性阑尾炎患者按随机自愿原则分为肠镜治疗组34例,手术治疗对照组45例,内科治疗对照组15例.手术治疗组予开腹阑尾切除术治疗,内科治疗组予甲硝唑及头孢西丁治疗,肠镜治疗组在内科治疗基础上加肠镜下治疗.对比分析3组患者的住院天数、平均费用、1年内复发例数、腹痛解除天数的差别.结果 肠镜组住院天数（2.77±0.27）d、平均费用（1011.35±22.12）元、1年内复发率2.9％（1/34）、腹痛解除天数1.2d,均明显优于内科治疗组的住院天数（7.64±1.52）d、平均费用（3978.63±33.02）元、1年内复发率33.3％ （5/15）、腹痛解除天数3.9d,亦优于手术组的住院天数（6.65±1.68）d、平均费用（ 4023.37±32.02）元,差异有统计学意义（P＜0.05）.结论 结肠镜治疗急性阑尾炎安全有效,可作为首选治疗手段.

Objective To study the effect of endoscopic treatment for acute appendicitis （AA）without perforation or gangrene.Methods A total of 94 patients with AA were randomly divided into operation group （n =45 ） to receive appendectomy,control group （n =15 ） to accept conventional medicine of metronidazole and Cefoxitin and colonoscopy group （n =34） to undergo conventional medicine plus endoscopic treatment.The time for alleviation of abdominal pain,duration and mean cost of the hospitalization,and the recurrence rate in one year were compared.Results Compared to operation group,colonoscopy group was superior in the duration [ （2.77 ± 0.27） d vs.（6.65 ± 1.68） d ] and mean cost of hospitalization [ （ 1011.35 ± 22.12） yuan vs.（4023.37 ± 32.02 ） yuan ] （ P 〈 0.05 and P 〈 0.01,respectively）.There were no significant differences in the time for alleviation of abdominal pain or the recurrence rate in one year between 2 groups.Colonoscopy group was superior to control group in all the indices （P 〈 0.05 ）.Conclusion Endoscopic treatment for AA without perforation and gangrene is effective and safe,which can be considered as the first-line treatment.