内镜下逆行阑尾炎治疗术对急性阑尾炎的临床效果评估

Effectiveness evaluation of endoscopic retrograde appendicitis therapy in treating patients with acute appendicitis

目的探讨内镜下逆行阑尾炎治疗术(ERAT)在急性阑尾炎治疗中的效果及手术技巧。方法将2016年12月—2017年6月我院收治的42例拟诊为急性阑尾炎患者纳入研究,行ER AT,分析治疗效果及手术技巧。结果 42例患者中6例阑尾插管失败,转外科手术治疗。余36例患者均顺利完成ERAT术,术中发现结肠镜前端置长透明帽或者患者仰卧位时可提高插管成功率。ERAT平均手术时间为(45.3±23.2)min,平均住院日(5.9±1.8)d。11例患者造影未见明显管腔狭窄,给予替硝唑氯化钠注射液给予局部冲洗治疗;25例患者造影可见块状粪石或者阑尾腔内絮状物,予以取石球囊或者网篮取出块状粪石或粪石碎渣,取石成功率100%;11例患者给予放置阑尾支架,1例患者术后发现阑尾周围脓肿形成转外科手术治疗;2周左右后复查结肠镜均将支架顺利取出,无相关并发症。结论 ERAT治疗急性阑尾炎可行有效,具有创伤少、恢复快、术后并发症少等优点。掌握插管及防止复发操作技巧可提高手术成功率。

Objective To study the effectiveness evaluation and skills of endoscopic retrograde appendicitis therapy(ERAT) in treating patients with acute appendicitis. Methods We enrolled 21 patients with suspected acute appendicitis who then underwent emergent ERAT between December 2016 and June 2017.The data of treatment were collected and the operative skills and effects of ERAT were analyzed.Results In the 42 patients,6 patients suffered from appendiceal failure and underwent surgical treatment.ERAT was completed successfully in 36 patients,and the success rate of intubation was improved when colonoscopy was found in the front of the colonoscopy and the patient supine position.Mean operation time of ERAT was(45.3±23.2)min and mean hospital stay was(5.9±1.8)d.In 11 patients,no obvious lumen stenosis was observed,and local rinsing treatment was given to tinidazole sodium chloride injection.A total of 25 patients were found to have lumpy dung or a flocculent in the appendectomy cavity,which could be used to take out a stone balloon or a net basket to remove the lumps of debris or debris,and the success rate was 100%.In 11 patients,the appendix stent was placed,and one patient found that the periappendiceal abscess was transformed into surgical treatment.The stent was successfully removed after 2 weeks or so,with no associated complications. Conclusion ERAT is effective in treating acute appendicitis.It has the advantages of less trauma,faster recovery and less postoperative complications.Mastering intubation and preventing recurrence operation technique can improve the operation success rate.