腹腔镜探查并阑尾切除术治疗异位阑尾炎19例临床分析

Clinical analysis of 19 cases of ectopic appendicitis with laparoscopic exploration and appendectomy

目的 探讨异位阑尾炎的临床表现、诊断要点及腹腔镜治疗的策略.方法 对新疆医科大学第二附属医院2011年4月-2015年4月间收治的19例异位阑尾炎的临床资料进行回顾性分析,总结其临床表现、诊治、腹腔镜探查指征及腹腔镜阑尾切除术的技巧.所有患者均在气管插管全麻下行腹腔镜探查＋腹腔镜阑尾切除术.结果 19例患者中,术前有16例经B超检查得到确诊,B超确诊率为92.63％;3例急性局限性腹膜炎患者术前误诊,分别为右侧肾结石、急性胆囊炎、右侧附件炎各1例;中转开腹手术2例,手术中转率为10.53％.术中出血5～ 20 mL,术后9h下床活动,12 h进全流质饮食;平均住院时间4d.戳孔处感染1例,全腹腔镜手术的并发症发病率为5.27％,术后随访12 ～18个月未发现其他远期并发症.结论 异位阑尾炎无特异性的临床表现,易误诊.辅助检查中,超声检查是诊断异位阑尾炎的首选检查手段.腹腔镜探查术＋腹腔镜阑尾切除术是急诊治疗异位阑尾炎的理想术式,值得临床推广.

Objective To explore the clinical manifestations,diagnosed main points,laparoscopic trestment strategy of ectopic appendicitis.Methods The 19 clinical data of ectopic appendicitis,from April 2011 to April 2015 in our hosipital,were retrospective analysised,and we sum up the clinical manifestation,diagnosis and treatment,laparoscopic exploration indications and the technique of laparoscopic appendectomy.Laparoscopy exploration and laparoscopic appendectomy were made on all patients under general anesthesia by tracheal cannula.Results Of 19 patients,16 cases by ultrasonic examination get correct diagnosis before operation,of which the ultrasound diagnosis rate is 92.63％,3 limitations of acute peritonitis patients were preoperative misdiagno^s,they were the right kidney stones,acute cholecystitis and the right side of the annex inflammation;there were 2 patients converted to open operation,and the transfer rate is 10.53％.The blood loss of the operation is about 5-20 mL.They were ambulant after 9 hours,in full flow diet after 12 hours,and the average hospitalization time is 4 days.One patient,no other long-term complications were found postoperatively follow-up of 12 to 18 months,were poke holes in infection,and the complications of laparoscopic surgery is 5.27％.Conclusions Ectopic acute appendicitis has no specific clinical manifestation,and is easy to misdiagnosis.In the auxiliary examination,ultrasound is the first choice for the diagnosis of ectopic appendictis.Laparoscopy exploration and laparoscopic appendectomy are the ideal treatments of emergency treatment of ectopic appendicitis,and are worth of clinic application.