阑尾根部异常肿胀的病理分析及手术治疗  

Pathological analysis and surgical treatment for abnormally swollen appendiceal root

作　　者：陈建发[1] 陈引香[1] 肖建秋[1] 傅明[1] 朱文彬[1] 冯巧智[1] 

机构地区：[1]中国人民解放军第422中心医院普外科,广东湛江524009

出　　处：《海南医学》2010年第24期78-79,共2页Hainan Medical Journal

摘　　要：目的回顾性分析阑尾根部异常肿胀的病理特点和应用浆肌层下剥除法治疗的临床疗效。方法 62例阑尾根部异常肿胀患者,术中按常规阑尾切除术步骤钳夹结扎游离阑尾系膜至根部。于距阑尾根部1.0cm处用电刀环行切开阑尾浆肌层,在阑尾黏膜下层向根部钝性游离阑尾黏膜至阑尾在盲肠壁的开口处,1#丝线结扎一道。在距结扎线远端0.5cm处钳夹去除阑尾黏膜及阑尾,电刀烧灼阑尾黏膜残端后,4#丝线间断缝合浆肌层。术后禁食1-3d,常规行输液抗炎治疗3-5d。结果 62例患者中急性坏疽性阑尾炎27例,急性化脓性阑尾炎35例。其中有16例于阑尾根部的阑尾腔内出现粪石堵塞。本组病例全部治愈,手术时间23-120min,平均38.2min,住院时间5-26d,平均6.6d。术后除2例出现切口感染外,无粪瘘、腹腔脓肿、残端出血等其他并发症发生。结论阑尾根部异常肿胀时阑尾壁炎症重,且常出现阑尾根部阑尾腔内粪石堵塞。应用浆肌层下剥除法切除阑尾,既能解除阑尾腔近段可能存在的粪石等梗阻,又可以预防术后粪瘘、残端出血、腹腔脓肿等严重并发症发生,为处理异常肿胀无法荷包包埋的阑尾残端提供了一种新的手术方法。Objective To retrospectively analyze the pathological characteristics of abnormally swollen ap-pendiceal root and the clinical efficacy of subseromuscular stripping.Methods 62 cases with abnormally swollen appendiceal root were analyzed.After separating the appendiceal mesentery to the root according to the routine appendectomy,the subseromuscular layer was cut circularly 1.0cm away from the root and the appendix was freed through the submucous layer to the appendiceal opening at cecum.The appendix was resected 0.5cm away from the ligation after ligating the appendiceal mucosa at the opening.The mucosal stub was dealed with electric knife and then the subse-romuscular layer was sutured.Postoperational fasting was recommended from 1 to 3 days and antibiotics was commonly given from 3 to 5 days after operaion.Results 262 cases with abnormally swollen appendiceal root consisted of 27 cases with acute gangrenous appendix and 35 cases with acute suppurative appendix,among which fecalith was found in 16 cases at the appendiceal opening.All patients were cured.Operational time varied from 23 to 120 minutes with the average time 38.2 minutes.The average length of stay was 6.6 days which varied from 5 to 26 days.Exception for 2 cases of infection of incisional wound,no complications such as fecal fistula,peritoneal abscess and stub bleeding occurred.Conclusion Severe inflammation was commonly found in abnormally swollen appendiceal root,and fecalith was often found too.Subseromuscular stripping is a new safe and effective way to remove abnormally swollen appendiceal root which can both relieves the fecalith at the appendiceal opening and prevent such severe com-plicatios as fecal fistula,peritoneal abscess and stub bleeding.

关 键 词：阑尾 病理 手术治疗 

分 类 号：R656.8[医药卫生—外科学]