腹腔镜阑尾切除术治疗异位阑尾炎的效果观察

Observation on efficacy of laparoscopic appendectomy for treating ectopic appendicitis

目的探讨腹腔镜下异位阑尾炎的诊疗体会。方法 33例异位阑尾炎患者,年龄6～75岁,表现为腹痛,伴恶心呕吐,合并高热、腹泻;查体有腹肌紧张,局部压痛、反跳痛;均在全麻下行腹腔镜探查术及阑尾切除术。结果 33例异位阑尾炎中盆位阑尾炎8例(24. 2%),左位阑尾炎5例(15. 2%),高位阑尾炎13例(39. 4%),腹膜后阑尾炎6例(18. 2%),盲肠壁内阑尾炎1例(3. 0%),均行腹腔镜阑尾切除术,手术时间为(20. 5±5. 5) min,术中出血量为(3. 5±1. 5) m L,术后肛门排气时间为(18. 5±4. 2) h,住院时间为(3. 32±1. 35) d。术后病理证实为阑尾炎。术后恢复良好,未见切口感染、腹腔脓肿、肠梗阻等并发症。结论异位阑尾炎临床症状不典型,术前确诊率低,应予以重视,腹腔镜下探查及治疗具有明显的优势。

Objective To explore the experience of diagnosis and treatment for ectopic appendicitis under laparoscope. Methods Thirty-three ectopic appendicitis patients aged 6-75 years had the manifestations of abdominal pain,nausea and vomiting,and were complicated with hyperpyrexia and diarrhea.The physical examinations manifested as abdominal muscle tension,local tenderness and rebound tenderness.All cases received laparoscopic exploration and appendectomy under general anesthesia. Results Of 33 cases with ectopic appendicitis, pelvic appendicitis, left-side appendicitis, high-positioned appendicitis,retroperitoneal appendicitis and cecal intramural appendicitis were found in 8 cases（24. 2%）,5 cases（15. 2%）,13 cases（39. 4%）,6 cases（18. 2%） and 1 cases（3. 0%） respectively. All cases received laparoscopic appendectomy. The operative duration was（20. 5 ± 5. 5） min,intraoperative blood loss was（3. 5 ± 1. 5） m L,duration for anal exhaust was（18. 5 ± 4. 2） h and hospital stay was（3. 32 ± 1. 35） d. All cases were confirmed as appendicitis by postoperative pathology. No complications including incision infection,intraperitoneal abscess and ileus were found. Conclusion Ectopic appendicitis deserves attention due to its atypical clinical symptoms and low preoperative diagnosis rate. Laparoscopic diagnosis and treatment obtains obvious advantages.