内镜逆行阑尾炎治疗术在急性非穿孔阑尾炎中的应用研究

Application of endoscopic retrograde appendicitis therapy in non-perforated acute appendicitis

目的探讨在急性非穿孔阑尾炎治疗中采用内镜逆行阑尾炎治疗术(ERAT)的疗效及安全性。方法选取2012年6月至2015年6月收治的195例急性非穿孔阑尾炎患者作为研究对象,经详细介绍ERAT、三孔法腹腔镜阑尾切除术和开腹阑尾切除术的治疗方法及其优缺点后,根据患者的意愿选择ERAT、三孔法腹腔镜阑尾切除术或开腹阑尾切除术,根据支架植入是否成功和治疗方法的不同,将195例患者分为A组(57例)、B组(24例)、C组(57例)和D组(57例)。A组和B组行ERAT(支架置入成功的患者归为A组,支架置入失败的患者归为B组),而C组和D组分别行腹腔镜阑尾切除术和开腹阑尾切除术。统计四组的治疗情况、机体免疫功能指标和不良事件发生情况。结果 ERAT组(A、B组)的术后6 h和12 h腹痛VAS分数<3发生率明显高于D组(P均<0.0071;行R×C表χ2检验分割法时,取α'=0.071);A组术后24 h白细胞恢复正常发生率明显高于B组(P<0.0071);ERAT组(A、B组)的术后即刻正常活动发生率明显高于外科手术组(C、D组,P均<0.0071),而术后卧床时间、住院天数和住院费用均明显低于外科手术组(P均<0.05);A组的半年内阑尾炎复发率明显低于B组,而D组的切口感染率明显高于C组(P<0.0071);各组术后24 h的C反应蛋白、白细胞介素6和白细胞介素8的浓度均明显高于术前,但以外科组(C、D组)增加幅度最明显(P均<0.05)。结论 ERAT治疗急性非穿孔阑尾炎的疗效明确,同时可节省医疗资源,并对患者损伤小。ERAT的疗效与是否成功置入支架关系密切。

Objective To investigate the efficacy and safety of endoscopic retrograde appendicitis therapy（ ERAT） in non-perforated acute appendicitis. Methods A total of 195 patients with non-perforated acute appendicitis treated from June 2012 to June 2015 were selected as study objects. ERAT,three-port laparoscopic appendectomy and open appendectomy were freely chosen according to the patient＇s wishes,and the patients were divided into group A（ ERAT with stent implantation,n = 57）,group B（ ERAT failed to stent implantation,n = 24）,group C（ three-port laparoscopic appendectomy,n = 57） and group D（ open appendectomy,n = 57）. The treatment outcome,indicators of immune functions and adverse events were observed and compared among four groups. Results The incidence of abdominal pain of visual analogue scale（ VAS） scores less 3 at 6-hour and 12-hour after operation in group A and B were significantly higher than that in group D（ all P 0. 0071; when using partitions of χ2mothod,α＇ = 0. 0071）. The incidence rate of white blood cells count back to normal at postoperative 24 hours in group A was significantly higher than that in group B（ P 0. 0071）. In group A and B,the incidences of recovering normal activities immediately after surgery were significantly higher than those in group C and D; the postoperative bed time,hospitalization stay and cost of hospitalization were statistically lower than those in group C and D（ all P 0. 05）. The recurrence rate of appendicitis 6 months after operation in group A was significantly lower than that in group B,and the incision infection rate in group D was obviously higher than that of group C（ P 0. 0071）. The levels of C-reactive protein,interleukin（ IL）-6 and IL-8 24 hours after operation were all significantly higher than those before operation in all groups especially in group C and group D（ all P 0. 05）. Conclusions The curative effect of ERAT for the treatment of acute non-perforated appendicitis is clear with the advantages of saving medical resources and less damage to patients. The efficacy of ERAT is closely related to whether the stent successfully was implanted.