阑尾结石并发粘液囊肿2例报告

我科自1990——1995年1月共收治阑尾粘液囊肿5例,均经手术及病理证实,其中2例阑尾腔内有较大结石阻塞,现报告讨论如下。 例1,患者,男36岁。以慢性阑尾炎急性发作行手术治疗。术中见:阑尾位于盲肠后位,似香蕉状,约有6×3×2cm大小,充血、肿胀,无脓苔,顶部呈囊性变与部分大网膜粘附,阑尾基底部正常。行阑尾截除术一并切除粘连之大网膜。阑尾标本为:远端腔内光满乳白色胶冻样物。腔内有黄白色钙化结石一块,3×1.5×1.5cm大小,嵌顿于中下段。

Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy

Acute appendicitis(AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy(LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Nonoperative management of AA may be tolerated only in children. Postoperative complications increase according to the patient's factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon's skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner(i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.

Retention mucocele of distal viable remnant tip of appendix:An unusually rare late surgical complication following incomplete appendectomy

A 67-year old man was presented with a 6-mo history of recurrent right lower quadrant abdominal pain. On physical examination, a vague mass was palpable in the right lumbar region. His routine laboratory tests were normal. Ultrasonography showed a hypoechoic lesion in the right lumbar region anterior to the right kidney with internal echoes and fluid components. Abdominal contrast-enhanced computed tomography （CECT） showed a well-defined hypodense cystic mass lesion lateral to the ascending colon/caecum, not communicating with the lumen of colon/caecum. After complete open excision of the cystic mass lesion, gross pathologic examination revealed a turgid cystic dilatation of appendiceal remnant filled with the mucinous material. On histopathological examination, mucinous cyst adenoma of appendix was confirmed. We report this rare unusual late complication of mucocele formation in the distal viable appendiceal remnant, which was leftover following incomplete retrograde appendectomy. This unusual complication is not described in the literature and we report it in order to highlight the fact that a high index of clinical and radiological suspicion is essential for the diagnosis of mucocele arising from a distal viable appendiceal remnant in a patient who has already undergone appendectomy presenting with recurrent abdominal pain.

Primary epithelial tumours of the appendix in a black population:A review of cases

AIM： To determine the and clinical features of prevalence, histologic types primary epithelial tumours of the vermiform appendix in a predominantly black population.METHODS： All cases of primary tumours of the appendix identified by review of the histopathology records at the University of the West Indies between January 1987 and June 2007 were selected. Relevant pathologic and clinical data were extracted with supplementation from patient charts where available. Non-epithelial tumours were excluded. The total number of appendectomy specimens over the period was also ascertained.RESULTS： Forty-two primary epithelial tumours were identified out of 6 824 appendectomies yielding a prevalence rate of approximately 0.62%. Welldifferentiated neuroendocrine cell tumours （carcinoids, 47.6%） and benign non-endocrine cell tumours （adenomas, 45.2%） were most common with nearly equal frequency. The median age was 43 years, with no sex predilection. Carcinoid tumours occurred in younger patients （mean age 32 years）, with a male-to-female ratio of 1.2：1. A clinical diagnosis of acute appendicitis was the most common reason for appendectomy （57.1%） and was histologically confirmed in 75% （18 of 24） of cases. In total, 16.7% of cases were diagnosed after incidental appendectomy.CONCLUSION： Appendiceal epithelial tumours are rare in our experience, and are represented principally by carcinoid turnours and adenornas. Carcinoid tumours occurred in younger patients but were slightly more common in men than women. Tumours were not suspected clinically and were diagnosed incidentally in specimens submitted for acute appendicitis supporting the need for histological evaluation in all resection specimens.

Prior appendectomy and the phenotype and course of Crohn's disease

AIM： To determine whether prior appendectomy modifies the phenotype and severity of Crohn＇s disease. METHODS： Appendectomy status and smoking habits were specified by direct interview in 2838 patients consecutively seen between 1995 and 2004. Occurrence of complications and therapeutic needs were reviewed retrospectively. Additionally, annual disease activity was assessed prospectively between 1995 and 2004 in patients who had not had ileocecal resection and of a matched control group. RESULTS： Compared to 1770 non-appendectomized patients, appendectomized patients more than 5 years before Crohn＇s disease diagnosis （n=716） were more often females, smokers, with ileal disease. Cox regression showed that prior appendectomy was positively related to the risk of intestinal stricture （adjusted hazard ratio, 1.24; 95% confidence interval, 1.13 to 1.36; P=0.02） and inversely related to the risk of perianal fistulization （adjusted hazard ratio, 0.75; 95% confidence interval, 0.68 to 0.83; P=0.002）. No difference was observed between the two groups regarding the therapeutic needs, except for an increased risk of surgery in appendectomized patients, attributable to the increased prevalence of ileal disease. Between 1995 and 2004, Crohn＇s disease was active during 50% of years in appendectomized patients （1318 out of 2637 patientyears） and 51% in non-appendectomized patients （1454 out of 2841 patient-years; NS）. CONCLUSION： Prior appendectomy is associated with a more proximal disease and has an increased risk of stricture and a lesser risk of anal fistulization. However, the severity of the disease is unaffected.

APPLICATION OF ACUPUNCTURE ANESTHESIA TO APPENDECTOMY AND COMMENTS ON THE OPERATION AND ITS POSSIBLE MECHANISMS

Objectives: To observe the analgesic effect and to analyze the related mechanisms of acupuncture anesthesia (AA) for appendectomy. Methods: A total of 41 cases of appendicitis patients (24 males and 17 females) were subjected into this observation. Electroacupuncture (AA, 60-100 Hz, a bearable stimulus strength) of Pishu (BL 20), Weishu (BL 21), Zhangmen (LR 13) and Wushu (GB 27) was performed beginning 30 minutes before operation. Adjuvants used were luminal (100 mg, intra muscular injection), dolantin (1 mg/kg), 0.5% procaine (1-2 mL). Results: Of the 41 cases, the successful rate was 87.80% and the excellent plus good rate was 75.61% respectively. Conclusion: Acupuncture anesthesia is applicable for appendectomy in clinic but is still to be improved further in operation.