一次性胰胆管成像系统辅助内镜逆行阑尾炎治疗术在急性阑尾炎中的应用效果  

Application of sub-endoscopic retrograde appendicitis therapy to acute appendicitis

作　　者：曹守莉 薛冬云 李君山[1] 闫金铭 李松[1] 李晓沛[1] Cao Shouli;Xue Dongyun;Li Junshan;Yan Jinming;Li Song;Li Xiaopei(Department of Gastroenterology,Shandong Provincial Third Hospital,Cheeloo College of Medcine,Shandong University,Jinan250000,China)

机构地区：[1]山东大学附属山东省立第三医院消化内科,济南250000

出　　处：《中华消化内镜杂志》2024年第11期895-900,共6页Chinese Journal of Digestive Endoscopy

摘　　要：目的比较内镜逆行阑尾炎治疗术(endoscopic retrograde appendicitis therapy,ERAT)与一次性胰胆管成像系统辅助内镜逆行阑尾炎治疗术(sub-endoscopic retrograde appendicitis therapy,SERAT)在急性阑尾炎中的疗效。方法回顾性纳入2021年11月至2023年4月山东省立第三医院收治的行SERAT或ERAT治疗的51例急性阑尾炎连续病例,其中SERAT组21例,ERAT组30例,比较两组患者的基线资料、临床治疗情况、住院费用和住院时间,并随访并发症和复发率等。结果两组患者的年龄、性别、临床表现、实验室和影像学资料、Alvrrado评分等基线资料差异均无统计学意义(P>0.05)。与ERAT组相比,SERAT组的手术时间更短[(23.6±10.1)min比(44.8±18.8)min,t=4.679,P<0.001]。两组支架置入率[61.9%(13/21)比70.0%(21/30),χ^(2)=0.364,P=0.546]、粪石取出率[38.1%(8/21)比33.3%(10/30),χ^(2)=0.123,P=0.726]、术后体温恢复正常时间(0~1 d、>1~3 d和>3 d分别为19、2、0例和26、3、1例,χ^(2)=0.723,P=0.697)、术后白细胞计数恢复正常时间(0~1 d、>1~3 d和>3 d分别为20、1、0例和27、2、1例,χ^(2)=0.813,P=0.666)、术后6 h腹痛视觉模拟量表评分<3分占比[100.0%(21/21)比90.0%(27/30),χ^(2)=2.231,P=0.135]、住院时间[(3.4±1.2)d比(4.5±2.9)d,t=1.579,P=0.121]、住院费用[(15393.0±4352.5)元比(17836.0±5134.6)元,t=1.777,P=0.082]、并发症发生率[0.0%(0/21)比0.0%(0/30),χ^(2)=0.000,P=1.000]等差异均无统计学意义。SERAT组复发率明显低于ERAT组[0.0%(0/21)比23.3%(7/30),P=0.017]。结论SERAT治疗急性阑尾炎安全有效,与ERAT比较手术时间更短、复发率更低,为急性阑尾炎提供了内镜直视化、微创化的治疗方法。Objective To compare the efficacy of endoscopic retrograde appendicitis therapy(ERAT)and sub-endoscopic retrograde appendicitis therapy(SERAT)for the treatment of acute appendicitis.Methods The retrospective study was performed on consecutive patients who underwent SERAT(21 cases)and ERAT(30 cases)for acute appendicitis in Shandong Provincial Third Hospital from November 2021 to April 2023.Patient baseline information,clinical treatment,hospitalization costs,and hospital stay were analyzed,and complications and recurrence were followed up.Results There was no significant difference between the two groups regarding age,gender,clinical manifestation,laboratory and imaging data,or Alvrrado score(P>0.05).Compared with the ERAT group,the operation time was shorter in the SERAT group(23.6±10.1 min VS 44.8±18.8 min,t=4.679,P<0.001).There were no significant differences between the two groups in stent implantation rate[61.9%(13/21)VS 70.0%(21/30),χ^(2)=0.364,P=0.546],fecalith removal rate[38.1%(8/21)VS 33.3%(10/30),χ^(2)=0.123,P=0.726],postoperative time for temperature(19,2,0 and 26,3,1 cases after 0 to 1 day,>1 to 3 days and>3 days,respectively,χ^(2)=0.723,P=0.697)and white blood cell count normalization(20,1,0 and 27,2,1 cases after 0 to 1 day,>1 to 3 days and>3 days,respectively,χ^(2)=0.813,P=0.666),proportion of visual analogue scale scores<3 at 6 hours after treatment[100.0%(21/21)VS 90.0%(27/30),χ^(2)=2.231,P=0.135],length of hospital stay(3.4±1.2 days VS 4.5±2.9 days,t=1.579,P=0.121),hospitalization cost(15393.0±4352.5 yuan VS 17836.0±5134.6 yuan,t=1.777,P=0.082),or incidence of complications[0.0%(0/21)VS 0.0%(0/30),χ^(2)=0.000,P=1.000].The recurrence rate in SERAT group(0.0%,0/21)was significantly lower than that in ERAT group(23.3%,7/30)(P=0.017).Conclusion SERAT is a safe and effective minimally invasive approach for managing acute appendicitis,characterized by a shorter operation duration and a lower recurrence rate compared to ERAT.

关 键 词：阑尾炎 内镜逆行阑尾炎治疗术 一次性胰胆管成像系统 微创 

分 类 号：R656.8[医药卫生—外科学]