急性盲肠炎的临床诊治探讨

Exploration of clinical diagnosis and treatment for acute typhlitis

目的 提高对急性盲肠炎的诊治水平。方法 1999年 2月～ 2 0 0 1年 8月收治 5例急性盲肠炎 ,5例术前均误诊为急性阑尾炎而急诊手术 ,术中分别误诊为肿瘤 2例、克罗恩病 2例、憩室炎 1例。 4例行右半结肠切除术、1例行坏死包块切除和末端回肠造瘘术。结果 5例病理结果为盲肠急性非特异性炎症。术后均痊愈出院 ,随访 4～ 30个月恢复良好。结论 本病临床表现无特异性 ,酷似急性阑尾炎 ,术前诊断困难。术中发现多以盲肠外侧肿块为特征 ,也难与肿瘤或克罗恩病鉴别。

Objective To improve the understanding of acute typhlitis.Methods all 5 cases of acute typhlitis from February 1999 to August 2001 were reviewed,5 cases were preoperatively misdiagnosed as acute appendicitis and subsequently performed emergency operations.Moreover,misdiagnosis was made intraoperatively as tumor in 2 cases,Crohn disease in 2 cases and diverticulitis in 1 case.Right hemicolectomy was performed in 4 cases;resection of necrotic mass and ileostomy was performed in 1 case.Results The pathologic change was acute non-specific inflammation of cecum in 5 cases.All cases recovered uneventfully.They are in good condition during the follow-up range 4 to 30 months.Conclusions The clinical manifestation of typhlitis was nonspecific.It was extremely difficult to diagnose preoperatively.Inflammatory mass of external lateral wall of cecum was characteristic finding of typhlitis during laparatomy.It is difficult to differentiate from tumor or Crohn disease at intraoperation.Right hemicolectomy was satisfactorily recommended.