并发肠梗阻的盆腔位阑尾穿孔诊治分析

Clinical analysis of treatment of perforated pelvic appendicitis presenting with intestinal obstruction

目的总结并发肠梗阻盆位穿孔性阑尾炎的诊治经验。方法对2010年1月至2012年12月摩洛哥赛达特哈桑二世医院收治的31例合并肠梗阻的盆位穿孔性阑尾炎患者的临床资料进行回顾性分析。结果患者入院后均行剖腹探查、阑尾切除、腹腔引流手术，其中机械性肠梗阻8例，麻痹性肠梗阻23例，盆腔脓肿15例；围手术期感染性休克6例，多系统器官功能衰竭（MSOF）4例；术后腹腔残余感染和早期炎性肠梗阻5例，肺部感染3例，伤口感染7例。31例中治愈30例，死亡1例。结论盆位阑尾炎症状不典型，容易延误诊治；并发肠梗阻的盆位阑尾穿孔可导致休克、MSOF等严重后果，需及时手术；螺旋CT对盆位阑尾穿孔引起的肠梗阻诊断具有一定价值。

Objective To summarize the experience in early diagnosis and emergency treatment for perforated pelvic appendicitis presenting with intestinal obstruction. Methods Clinical data of 31 cases of perforated pelvic appendicitis presenting with intestinal obstruction admitted to Hassan Hospital from Jan. 2010 to Dec. 2012 were analyzed retrospectively. Results All the patients were treated with laparotomy, appendectomy and intraperitioneal drainage. There were 8 cases of mechanical intestinal obstruction undergoing enterolysis, 23 cases of paralytic ileus, and 15 cases of pelvic abscess. Perioperative septic shock occurred in 6 cases and multiple systemic organ failure （MSOF） in 4 cases. After operation,5 cases were complicated with early postoperative inflammatory ileus （EPII）, 3 with pneumonia and 7 with wound infection. Thirty cases were cured and one died. Conclusion Pelvic ap- pendicitis is atypical at early stage and easy to delay the diagnosis; perforated pelvic appendicitis pres- enting with intestinal obstruction could lead to shock and MSOF, and timely surgery is required. Spiral CT is of certain value in diagnosing these cases.