结肠镜下开窗术和阑尾腔内冲洗术治疗阑尾周围脓肿  

Colonoscopic fenestration and intracavity douching for preappendicular abscess

作　　者：冯佳[1] 冯子坛[1] 孙蓉[1] 郭丽丽[1] 刘文格[1] 姚欣[1] 于佳[1] 智佳[1] 刘斌[2] 

机构地区：[1]解放军白求恩国际和平医院消化内科,石家庄050082 [2]解放军总参谋部管理保障部保健处

出　　处：《中华胃肠内镜电子杂志》2014年第1期24-27,共4页Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)

摘　　要：目的探讨结肠镜下通过脓肿开窗术和对合并急性阑尾炎患者同时行阑尾腔内冲洗术,治疗阑尾周围脓肿方法的有效性和安全性。方法 2006年8月至2012年12月于解放军白求恩国际和平医院住院诊断为阑尾周围脓肿患者8例,均有右下腹压痛,2例右下腹可触及包块,术前均经腹部超声检查提示阑尾周围或右下腹包块、渗液。结肠镜检查后于回盲部或阑尾开口周围黏膜最隆起处或波动明显、有脓性分泌处行开窗术。术后观察患者临床情况、复查超声并随访。结果结肠镜下发现外压性隆起5例,黏膜隆起界限不清、充血、肿胀伴脓性分泌物3例,均行开窗术。其中1例合并阑尾炎的患者同时行结肠镜下阑尾腔内冲洗术。8例患者术后腹痛症状及腹部压痛均立即明显缓解,术后第4天腹部超声提示1例患者渗液及2例患者包块均未探及,余5例患者包块明显缩小。随访1例患者2年后复发。结论结肠镜下治疗阑尾周围脓肿是安全、有效的,合并阑尾炎的患者同时解除阑尾腔梗阻会有更加明显的效果。Objective To evaluate the safety and efficacy in treatment of periappendicular abscess by endoscopic fenestration of abscess and, at the same time, of merged acute appendicitis by intracavity douching. Methods From August 2006 to December 2012, 8 hospitalized hospitalized patients diagnosed with periappendicular abscess, during whom the physical examination had the fight lower quadrant tenderness in 8 cases and had palpable mass in the fight lower quadrant in 2 cases. Before the treatment, all the patients abdominal ultrasound examinations showed mass or exudate at right lower quadrant or around the appendix. Fenestration of ileocecal uplift mucosa was found to fluctuate significantly and to secrete with pus by colonoscopy. All the patients after the treatment were observed with clinical conditions, reviewed by the abdominal ultrasound and followed up. Results Eight cases were treated by fenestration and 1 case with merged acute appendicitis was given intracavity douching of appendix at the same time. There were 5 cases that had obvious external pressure mucosal uplift and 3 cases that had ill- defined redness, swelling with purulent secretions of mucosa uplift. After the treatment, all the patient had obviously relieved clinical symptoms,one patient＇s exudation and 2 patient＇s palpable masses were disappeared by ultrasound examination, in other 5 patients masses were significantly reduced. All the patients were followed up and one case recurred 2 years later. Conclusion It was safe and effective to perform endoscopic fenestration in treatment of periappendicular abscess, and it was more effective by intracavity douching of appendix for the patients with merged acute appendicitis.

关 键 词：结肠镜检查 腹腔冲洗 阑尾炎 脓肿 开窗术 

分 类 号：R656.8[医药卫生—外科学]