ObjectiveTo further explore and discuss the value of laparoscopic appendectomy. MethodsThe clinical data of 200 patients underwent appendectomy in this hospital from April 2009 to December 2010 were collected. The operation time, postoperative hospital stay, cost of hospitalization, postoperative anal exhaust time, postoperative pain score, and surgical complications were compared between laparoscopic appendectomy and open appendectomy. ResultsThere were 8 cases conversion to the open approach in this series. The cost of laparoscopic appendectomy was higher than that of open appendectomy (Plt;0.05); the cases of chronic appendicitis, acute simple appendicitis, acute suppurative appendicitis within 36 h of onset treated by laparoscopic appendectomy had shorter operation time, shorter postoperative hospital stay, earlier postoperative anal exhaust time, and slighter postoperative pain than those treated by open appendectomy (Plt;0.05); the differences in postoperative hospital stay, postoperative anal exhaust time, postoperative pain of acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis treated by two types of surgery had no statistical significances (Pgt;0.05); the operation time of acute gangrenous appendicitis operated by laparoscopic surgery was longer than that by open appendectomy (Plt;0.05); incision infection rate of laparoscopic appendectomy was lower than that of open appendectomy (Plt;0.05). ConclusionsFor chronic appendicitis, acute simple appendicitis, and acute suppurative appendicitis within 36 h of onset, the outcome and advantages of laparoscopic appendectomy are outstanding, the value of application is clear; and for acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis, laparoscopic appendectomy is difficult and with high rate of conversion, no obvious advantages in recovery after surgery but an increase of medical costs, and the application value is not great.
In order to inquire into the relation between bacterial L-forms and chronic appendictis,appendices removed from 10 patients with appendicitis were cultured with improved kagans’s solid medium and nutrient medium containing blood respectively.Bacterial forms with bacterial L-form transforms to L-forms and 1 strain of bacillus aerogen with its L-form.The result shows that bacterial form transforms to L-form,then to bacterial form may be related with appendicitis attack,alleviation and attack again.
Objective To present the concept and explore the diagnosis and treatment strategies of secondary appendicitis. To summarize the clinical features of secondary appendicitis caused by different related factors. Methods The clinical data of 660 patients with a presumptive diagnosis of acute appendicitis between November 2003 and November 2008 in The First Affiliated Hospital of Harbin Medical University were collected and analyzed retrospectively. Five hundred and ninetyfour patients with primary appendicitis (primary appendicitis group), and 66 patients with secondary appendicitis (secondary appendicitis group). Clinical parameters such as fever， nausea or vomit, abdominal pain, abdominal distension, change of defecation habits or characters, tenderness in the right lower abdominal quadrant, acute abdomen, abdominal mass, and WBC were compared between two groups. Results Biopsies of appendectomy were taken in all and the results showed inflammation. The pathogenic factors and cases of primary appendicitis: bacterial infection in 171 cases (25.91%), appendix cavity blocked by fecalith in 386 cases (58.48%), appendix cavity stricture in 33 cases (5.00%), and appendix deformity in 4 cases (0.61%). Sixty-six patients resulted from secondary appendicitis: colon carcinoma in 7 cases (1.06%) receiving laparocolectomy including 5 ascending colon and 2 transverse colon; gynecological disease in 20 cases (3.03%), 7 cases of right ovarian cyst accompanying adnexal torsion receiving oophorocystectomy combining with appendectomy, 5 right rupture of corpus luteum of ovary receiving right ovariectomy combining with appendectomy, 4 acute pelvic inflammation and pelvic abscess receiving transvaginal drainage of pelvic abscess combining with appendectomy, 4 extra-uterine pregnancy receiving right ovariectomy and salpingectomy combining with appendectomy; 9 cases (1.36%) of hernia, all to be right oblique hernia, receiving herniorrhaphy combining with appendectomy; Intestinal tuberculosis in 6 cases (0.91%), 4 cases receiving appendectomy, 1 case for resection of ileocecum, and 1 case for right hemicolectomy; parasitic disease in 24 cases (3.64%), all to receive appendectomy. There were significant differences in nausea or vomit, abdominal pain, abdominal distension, changes of defecation habit or character, tenderness in the right lower abdominal quadrant, abdominal mass, and WBC between two groups (Plt;0.05). There was no significant difference in fever or acute abdomen between two groups (Pgt;0.05). InclusionsAppendicitis could be secondary to many diseases. We must attach importance to the diagnosis of secondary appendicitis so that to decrease or avoid the appearance of missed diagnosis and misdiagnosed in the clinical.
目的比较腹腔镜阑尾切除术（LA）与传统开腹阑尾切除术（OA）在治疗老年（60岁）急性阑尾炎患者的临床疗效。方法回顾性分析2008年6月至2009年12月期间我院收治的67例老年急性阑尾炎患者的临床资料，根据接受的不同手术方式分为LA组（n=28）和OA组（n=39），对2组患者术中及术后相关指标进行比较。结果 LA组患者均顺利完成手术，无中转开腹; 术后无切口感染; 1例出现腹腔残余感染，经抗感染治疗后痊愈。OA组患者术后6例发生切口感染，经换药后痊愈; 5例发生腹腔残余感染，经抗感染治疗后痊愈。2组患者均无出血、阑尾残端漏、残株炎、粘连性肠梗阻等并发症发生。LA组患者手术时间与OA组比较差异无统计学意义（Pgt;0.05）。尽管LA组患者综合费用明显多于OA组（Plt;0.05），但术中出血量、术后下床时间、肛门排气时间、止痛剂使用率、切口感染率、腹腔残余感染率以及住院时间均小（少）于OA组（Plt;0.05）。 结论对老年急性阑尾炎患者的治疗，LA明显优于OA，且可作为老年急性阑尾炎患者治疗的首选术式。
目的 探讨应用传统器械经脐行改良单孔腹腔镜阑尾切除术的临床价值。方法 回顾性分析笔者所在医院2010年1月至2012年2月期间行经脐单孔腹腔镜阑尾切除术的52例阑尾炎患者的临床资料，总结手术经验。结果 52例患者均顺利完成手术，平均手术时间为39.2min （18～70min），术后平均住院时间为5d （3～12d）。其中，45例患者成功完成经脐单孔腹腔镜阑尾切除术，2例中转开腹，2例行两孔LA术，3例行三孔LA术。术后2例患者发生切口感染。29例患者获访，随访时间4～18个月，平均12个月，无出血、切口疝、腹腔残余感染、粘连性肠梗阻、阑尾残端瘘等并发症发生。结论 应用传统器械经脐行改良单孔腹腔镜阑尾切除术简单、安全、可行、患者恢复快、并发症少、美容效果较好，但操作难度相对更高。应严格掌握手术适应证，必要时及时增加戳孔或中转开腹。
ObjectiveTo investigate the effect of early enteral nutrition (EEN) support in the perioperative period of children with perforated appendicitis based on the enhanced recovery after surgery (ERAS). MethodsThe children with perforated appendicitis were collected as an observation group, who underwent EEN support treatment based on the ERAS mode from January 2021 to December 2022 in the Xuzhou Children’s Hospital. At the same time, the children with perforated appendicitis received conventional nutrition support from January 2019 to December 2020 were matched as a control group according to the principle of balanced and comparable baseline data such as the gender, age, disease course, pathological type, and body mass index with the observation group. The time of first exhaust or defecation and the hospital stay after surgery were compared. Meanwhile, the nutritional indexes [prealbumin (PA), albumin (ALB), hemoglobin (Hb)], immune indexes [immunoglobulin (Ig) A, IgM, IgG], serum inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)] before surgery, on day 1 and 7 after surgery were compared. And the adverse effects were observed. ResultsThere were 40 children with perforated appendicitis in the observation group and the control group, respectively. There were no statistical differences in the baseline data such as the gender, age, course of disease, pathological type, and body mass index between the two groups (P>0.05). The time of first exhaust or defecation and the hospital stay after surgery in the observation group were shorter than in the control group (t=3.234, P=0.002; t=5.582, P<0.001). The levels of PA, ALB, Hb, IgA, IgM, and IgG in the observation group were higher than in the control group on day 7 after surgery (P<0.05). The levels of CRP, IL-6, and TNF-α in the observation group were lower than in the control group on day 7 after surgery (P<0.05）. The incidence of adverse reactions in the observation group was lower than that in the control group [5.0% (2/40) vs. 22.5% (9/40), χ2=5.165, P=0.023]. ConclusionsFrom on the results of this study, EEN support based on ERAS during perioperative period of children with perforated appendicitis contributes to recover gastrointestinal function, correct nutritional status, improve immune function, and reduce inflammation, and which has a higher safety for children with perforated appendicitis.
目的 分析其他疾病误诊为急性阑尾炎的原因。方法 结合相关文献资料，对2004年2月至2008年12月期间本院21例其他疾病被误诊为急性阑尾炎的过程进行回顾性分析。结果 除了胆囊结石、胃穿孔、肠结核、异位妊娠等常见病可能被误诊为急性阑尾炎外，肝包虫、胆管癌、癔病、恶性淋巴瘤等也有可能被误诊为急性阑尾炎。误诊的主要原因是经治医生经验不足、思维局限、知识面狭窄，更重要的则是重视不足，检查不仔细、不全面。结论 系统和全面仔细地问诊、查体，努力提高辅助检查诊断水平等是减少误诊的关键。
ObjectiveTo analyze the multidetector computed tomography (MDCT) findings of normal appendices and appendices of acute appendicitis in old patients, and to explore the clinical value of MDCT in assessing acute appendicitis in old patients. MethodsSixty-six cases of acute appendicitis confirmed by surgery in 24 hours after MDCT scan from Jun. to Oct. 2016 (acute appendicitis group), and 40 cases underwent MDCT scan for non-abdominal pain causes without appendiceal lesions from Sep. to Oct. 2016 (normal appendices group), were included, and the MDCT images of both 2 groups were retrospectively analyzed. Observation items included:location, diameter, mural thickness, intra-luminal contents, and changes of surrounding structures. Results① Rate of appendices visualization. In total of 95.5% (63/66) appendices were visualized on MDCT in acute appendicitis group, while 95.0% (38/40) appendices were visualized on MDCT in normal appendices group (P > 0.05). ② Locations of appendices. Acute appendicitis group:appendices were found to be located at pelvic cavity in 22 cases, in front of ileum in 2 cases, behind ileum in 10 cases, below cecum in 25 cases, and behind cecum in 4 cases. Normal appendices group:appendices were found to be located at pelvic cavity in 15 cases, in front of ileum in 3 cases, behind ileum in 7 cases, below cecum in 5 cases, and behind cecum in 8 cases. There was significant difference between 2 groups in terms of location of appendices (P < 0.05). The appendices in acute appendicitis group located mainly at pelvic cavity and below cecum, while the appendices in normal appendices group located mainly at pelvic cavity. ③ The diameter and thickness of appendices. The appendiceal diameter and thickness in acute appendicitis group were (11.4±4.2) mm (6.2-21.9) mm and (4.3±2.2) mm (1.1-8.6) mm, respectively, while those in normal appendices group were (6.1±1.4) mm (3.7-8.6) mm and (1.7±0.8) mm (0.5-3.2) mm, respectively. The diameter and thickness of appendices in acute appendicitis group were significantly greater than those in normal appendices group, respectively (P < 0.05). ④ Contents of appendices. Acute appendices group:there was effusion with air in 14 cases in appendiceal cavity, full of effusion in 36 cases, and appendicolith combined with effusion in 13 cases. Normal appendices group:there was full of air in 15 cases in appendiceal cavity, air with a little faeces of higher density in 13 cases, and nothing in 10 cases. Effusion was more common in appendiceal cavity in acute appendicitis group, while air was more common in normal appendices group. ⑤ Around appendices. Fat stranding was seen in 57 cases, adjacent parietal peritoneum thickening was seen in 56 cases, focal effusion was seen in 18 cases, abscess was seen in 2 cases, free air in peritoneal cavity was seen in 8 cases, and lymphadenopathy was seen in 35 cases. None of these imaging features were seen in normal appendices group. ConclusionsMDCT can demonstrate features of normal appendices and acute appendicitis in old patients. MDCT yield high diagnostic accuracy in acute appendicitis in old patients, and can provide useful information before surgery.