阑尾切除术后再手术60例原因分析  

Causes of reoperation after appendectomy: A report of 60 cases

作　　者：潘博 周建平[1] 董明[1] 盛伟伟[1] PAN Bo;ZHOU Jian-ping;DONG Ming(Department of Gastrointestinal Surgery,First Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院胃肠外科,辽宁沈阳110001

出　　处：《中国实用外科杂志》2018年第12期1425-1427,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨阑尾切除术后再次手术的原因及防治。方法回顾性分析中国医科大学附属第一医院胃肠外科2011年1月至2017年5月收治的60例阑尾切除术后再次手术病人的临床资料。结果 60例病人初次手术时,阑尾炎急性发作38例(63.3%),慢性发作22例(36.7%);51例(85.0%)病人急诊行阑尾切除术,9例(15.0%)择期手术,其中探查切口39例(65.0%),麦氏切口21例(35.0%);60例病人均行开放式阑尾切除术。术后病理学检查结果:急性单纯性阑尾炎25例(41.7%)、急性化脓性阑尾炎17例(28.3%)、坏疽性及穿孔性阑尾炎6例(10.0%)、慢性阑尾炎10例(16.7%)、腺癌2例(3.3%);初次手术所在医院为二级医院47例(78.3%),三级医院13例(21.7%)。再次手术原因包括:肠梗阻27例(45.0%),腹壁切口疝26例(43.3%),炎症性并发症7例(11.7%)。再次手术方式包括:切口疝修补术26例(43.3%),肠粘连松解术23例(38.3%),回盲部切除术3例(5.0%),根治性右半结肠切除术3例(5.0%),阑尾残株切除术2例(3.3%),右半结肠切除术1例(1.7%),脓肿切开引流术1例(1.7%),剖腹探查术1例(1.7%)。结论阑尾切除术后再次手术的原因以肠梗阻、腹壁切口疝及炎症性并发症为主。开放性阑尾切除术可能会增加再次手术的风险。初次手术操作规范,腹腔冲洗彻底,切口缝合确切可减少阑尾切除术后再手术率。Objective To explore the causes and prevention of reoperation after appendectomy.Methods The clinical data of 60 cases underwent second surgery after appendectomy in the First Affiliated Hospital of China Medical University from January 2011 to May 2017 were analyzed retrospectively.Results For the initial surgery in 60 cases, 38 cases (63.3%)had acute appendicitis and 22 cases(36.7%)had chronic symptoms;51 cases (85%) received emergency surgery and 9 cases(15%)received elective surgery.They all underwent open appendectomy.A total of 39 cases(65%)were treated by exploratory incision and 21 cases (15%)were treated by McBurney incision.The postoperative pathology showed that:25 cases(41.7%)with acute simple appendicitis;17 cases(28.3%)with acute suppurative appendicitis and 6 cases with gangrenous and perforated appendicitis(10.0%);10 cases with chronicappendicitis(16.7%)and the other 2cases with adenocarcinoma(3.3%).Among all the 60 cases,47patients (78.3%)choosed secondary hospital and 13 cases (21.7%)selected tertiary hospital.As for the causes of reoperation,27 cases (45.0%)arised from intestinal obstruction;26 cases (43.3%)arised from incisional hernia and 7cases (11.7%) were caused by the complications of inflammatory.Finally,surgeons executed incisional hernia repairment in 26patients (43.3%);intestinal adhesions in 23 cases(38.3%);ileocectomy in 3 cases(5.0%);radical right colon resection in 3cases (5.0%);appendieeal resection in 2 cases(3.3%);right hemectomy in 1 case(1.7%);abscess incision and drainage in 1 case (1.7%)and laparotomy in 1 case(1.7%).Conclusion The causes for reoperation after appendectomy are mainly intestinal obstruction,abdominal incisional hernia,and inflammatory complications.Open appendectomy may increase the risk of reoperation.Standard operation,complete peritoneal larage and incision suture may reduce the rate of postoperative reoperation.

关 键 词：阑尾切除术 再手术 

分 类 号：R6[医药卫生—外科学]