SpyGlass DS辅助内镜下逆行阑尾炎治疗术的诊治价值 (附视频)

The diagnostic and therapeutic value of SpyGlass DS assisted endoscopic retrograde appendicitis therapy

目的探讨SpyGlass DS辅助内镜下逆行阑尾炎治疗术(ERAT-S)的临床应用价值分析。方法纳入2019年1月至2020年4月吉林市人民医院收治的11例急性非复杂性阑尾炎患者,采用内镜下逆行阑尾炎治疗术(ERAT)的方法,结肠镜到达阑尾开口处,将SpyGlass DS插入阑尾腔内观察,并在直视下进行取石、冲洗等治疗。结果全部11例患者经SpyGlass DS确诊为急性非复杂性阑尾炎,SpyGlass DS镜下表现为阑尾腔内壁充血水肿11例(100%),腔内粪石5例(45.5%),腔内脓液及脓苔附着3例(27.2%),管腔走形迂曲、扩张或狭窄8例(72.7%);全部11例患者成功完成SpyGlass DS辅助的内镜下逆行阑尾炎治疗术,手术成功率100%(11/11),术中无转外科手术病例,无并发症发生;平均住院天数(4.3±1.7)d;随访无复发。结论ERAT-S对急性非复杂性阑尾炎具有确诊作用,通过取石、冲洗等方法,对急性非复杂性阑尾炎具有治疗作用,操作安全可行,值得临床进一步应用。

Objective To explore the value on diagnosis and treatment with SpyGlass DS assisted endoscopic retrograde treatment for acute appendicitis(ERAT-S).Methods Eleven patients with acute uncomplicated appendicitis were admitted to Jilin People's Hospital from January 2019 to April 2020.By applying ERAT,the colonoscope reached the opening of the appendix,and the Spyglass was inserted into the appendix cavity for observation.Then,the patients were treated by stone removal and irrigation under direct vision.Results All the 11 patients were diagnosed as acute uncomplicated appendicitis by Spyglass DS,And hyperemia and edema of mucous membranes can be seen in 11 cases(100%),intracavitary fecalith in 5 cases(45.5%),pus&pus adhesion in the appendix cavity in 3 cases(27.2%),and the lumen crooked,dilated or narrowed in 8 cases(72.7%)can be seen under the Spyglass DS.These patients were treated with ERAT-S with a success rate of 100%.None of the patients were referred to the general surgical department during the operation and no complications such as bleeding and perforation occurred after operation.The average hospital stay lasts for(4.3±1.7)days and no recurrence occured during the follow-up.Conclusion ERAT-S can be applied in the diagnosis of acute uncomplicated appendicitis by observation under direct vision.And it can be helpful in the treatment of acute uncomplicated appendicitis via stone removal and irrigation.Considering the safety and feasibility,this operation warrants further clinical application.