内镜逆行阑尾炎治疗术在阑尾疾病中的应用

目的探讨内镜逆行阑尾炎治疗(ERAT)在诊断和治疗阑尾疾病(阑尾粪石和急性单纯性阑尾炎)中的价值。方法2020年1月至2022年12月行肠镜或ERAT治疗的阑尾粪石及阑尾炎症患者20例,分析患者的手术时间、并发症发生率、随访期间的阑尾切除率、影像学表现及肠镜下表现等。结果患者年龄14~65岁,腹痛时间4 h至6年。11例患者ERAT治疗中见阑尾口黏膜充血,确诊急性阑尾炎,经ERAT治疗后腹痛好转。1例患者在随访期间复发行腹腔镜下阑尾切除术。1例确诊结肠炎,未行ERAT治疗。余8例患者均未见阑尾口充血水肿,行ERAT治疗冲洗阑尾粪石,术后患者腹痛缓解,其中2例患者在粪石取出术中使用取石蓝,1例患者术后随访复发行阑尾切除术,术后病理示慢性阑尾炎。结论ERAT是一种安全、有价值的检查方法,在诊断和治疗急性单纯性阑尾炎和阑尾粪石方面有一定的临床价值。

Objective To investigate the value of endoscopic retrograde appendicitis therapy(ERAT)in the diagnosis and treatment of appendiceal diseases(appendix fecalith and acute uncomplicated appendicitis).Methods Twenty patients with the diagnosis of appendix fecalith or uncomplicated acute appendicitis who underwent colonoscopy or ERAT from January 2020 to December 2022 were included in this study.Mean operative time,imaging findings and colonoscopy findings,rate of complication and rate of appendectomy during follow-up period were retrospectively reviewed.Results The patients ranged in age from 14 to 65 years.The duration of abdominal pain ranged from 4 hours to 6 years.Acute appendicitis was diagnosed in 11 patients with mucosal inflammation at the appendix opening during ERAT treatment.Abdominal pain relieve immediately after ERAT treatment,and 1 patient accepted laparoscopic appendectomy during follow-up.1 of them was diagnosed with colitis.8 patients showed mucosal inflammation or maturation at the appendix opening accepted ERAT,and removed fecalith,and their abdominal pain was relieved after surgery.Stone basket was used in two patients during extraction of fecalith.During follow-up period,only 1 patient underwent appendectomy,and the postoperative pathology showed chronic appendicitis.Conclusion ERAT is a safe and effective method to diagnose and treat acute uncomplicated appendicitis and appendix fecalith.