以急性完全性小肠梗阻为首发表现的急性阑尾炎诊治探讨  

Investigation of diagnostic method and treatment on acute appendicitis with acute intestinal obstruction as presenting manifestation

作　　者：张小虎[1] 李志霞[1] 安大立[1] 刘靖[1] 李伟[1] 

机构地区：[1]首都医科大学附属北京同仁医院普通外科,100730

出　　处：《中华胃肠外科杂志》2016年第4期432-435,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的总结以急性完全性小肠梗阻为首发表现的急性阑尾炎的疾病特点，减少误诊并为选择适宜的诊治方式提供参考。方法首都医科大学附属北京同仁医院普通外科于2000年1月至2015年12月期间．共收治了以急性完全性小肠梗阻为首发表现的33例急性阑尾炎患者，对这组病例的临床资料进行回顾性总结分析。结果33例患者均为急诊入院。发病至入院时间（62．2±25．0）h；入院时均伴有不同程度的腹痛、腹胀和停止排气排粪，影像学检查结果均符合急性完全性小肠梗阻诊断。21例（63．6％）伴有腹膜炎，其中3例（9．1％）合并感染中毒性休克。术前17例患者行腹部cT全部显示有小肠扩张积气积液，其中有13例提示急性阑尾炎。所有病例均采取手术治疗，其中12例行腹腔镜探查，21例剖腹探查，术中证实所有病例原发病为急性阑尾炎合并小肠梗阻，明确机械性小肠梗阻14例（42．4％），其中9例实施阑尾切除加肠粘连松解，5例阑尾切除加大网膜部分切除；另19例（57．6％）为麻痹性肠梗阻者行单纯阑尾切除术。术后有12例需要在重症监护病房（Icu）进行呼吸循环支持治疗，ICU治疗时间（8．8±5．2）d。术后病理证实，33例均为急性坏疽性阑尾炎伴穿孔。全组患者痊愈出院，住院时间（15．4±4．6）d。随访时间3-12月，除1例患者因慢性阻塞性肺病反复出现肺部感染而于术后185d死于呼吸衰竭外，其余患者随访期间未出现腹腔内残留感染、肠梗阻等手术相关并发症及死亡。结论以急性完全性小肠梗阻为首发表现的急性阑尾炎病情危重，临床诊断困难，应该尽快实施手术。Objective Prevention of the misdiagnosis of acute appendicitis when it first manifested as acute intestinal obstruction, and to search proper way of diagnosis and treatment for such event to provide the referenee. Methods Clinical data of 33 acute appendicitis eases presented with acute intestinal obstruction in Beijing Tong Ren Hospital during January 2000 and December 2015 were analyzed retrospectively. Results All 33 patients were admitted to the Emergency Department with symptoms of various degrees abdominal pain and abdominal distension. There was no passage of gas and feces. The mean time of onset was （62.2 ：t： 25.0） hours. The imaging examination showedthat all patients had complete bowel obstruction. Twenty one patients （63.6%） had peritonitis, three of whom developed with septic shock. Abdominal CT was performed in 17 patients preoperatively, which showed retention of gas and fluid in the small intestine in all the patients and 13 were suggestive of acute appendicitis. All of these patients received surgical treatment, 12 patients underwent laparoscopic exploration, and the remaining 21 patients received exploratory laparotomy during which acute appendicitis was confirmed to be the cause of intestinal obstruction, of whom 14（42.4%） was identifiedas mechanical intestinal obstruction. Nine patients underwent appendectomy and lysis of adhesion, five appendectomy and partial excision of the greateromentum. Nineteenpatients （57.6%） were identified as paralytic ileus and underwent appendectomy only. Twelve patients required respiratory and circulatory support and were admitted to ICU postoperatively. The mean duration time in ICU was （8.8 ＋ 5.2） days. Postoperative pathology showedgangrene accompanied with perforation in the appendix. All patients were discharged without any complication. The length of hospital stay was （15.4＋4.6） days. All patients were followed up for 3 ~ 12 months. One patient with chronic obstructive pulmonary disease developed repeated pulmonary infection a

关 键 词：阑尾炎 肠梗阻 误诊 

分 类 号：R656.8[医药卫生—外科学]