阑尾手术扩大回盲部切除44例临床分析

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1、阑尾手术扩大冋盲部切除44例临床分析【摘要】目的：探讨阑尾手术扩人回盲部切除术的指征，为临床外科提供治疗经验。方法：回顾性研究1999〜2008年在不同情况下1期施行的阑尾疾病扩大性回盲部切除术共44例，对其术中情况、手术方法、病理类型、疗效进行分析，与同期手术治疗的78例复杂性阑尾切除术进行比较。结果：44例1期施行的冋有部切除术患者均在术后2周内痊愈出院，手术并发症发生率为6.81%。而对照组凶肠梗阻、腹腔残余脓肿、肠痿、冋盲部或阑尾肿块而行2次手术者达18例，并发症发生率为23.08%，明显高于冋盲部切除术组(PvO.Ol)。结论:阑尾疾病合并小肠梗阻、盲肠壁裂口

2、、阑尾或冋盲部性质不明肿块等是施行冋盲部切除术的主要指征，可明显减少术后并发症。【关键词】阑尾切除术;回盲部;肿瘤;手术指征InvestigationofindicationsofileocecectomyinsurgicalmanagementofappendiclediseasesFANGTianling,LIUAnzhong,LIJun(DepartmentofHepatobiliarySurgery,FirstAffiliatedHospitalofGuangzhouMedicalCollegeGuangzhou510120,China)[ABSTRACT]Ob

3、jective:Todeterinineindicationsofileocecectomyinthesurgicalmanagementofappendiclediseasesandfindevidenceforclinicaltreatment.Methods:Dataof122patientswithappendiclediseaseswhounderwentoperativesurgeryfrom1999to2008werestudiedretrospectively,including44casesofphaseIileocectomyduetoappendi

4、clediseasesofnonappendicitis(GroupA)and78casesofappendectomyduetocomplexappendicitis(GroupB).Surgicalapproaches,findingsinsurgery,pathologyandeffectsoftreatmentofthemwereanalyzedandcompared.Results:FortyfourpatientsofgroupAwhounderwentphaseIileocectomywerecuredwith6.81%complicationsanddi

5、schargedin14days.OfthepatientsingroupB,18casesunderwentreoperationduetointestinalobstruction,abdominalabscess,fistula,appendicleorileocecallumps,theincidenceofcomplicationswas23.08%.Comparedthetwogroupsforcomplication,therewassignificantdifference(PvO.Ol).Conclusion:Ileocecectomyindicate

6、spredominantlytopatientswithinconclusiveseriousappendiclediseasesand/orordinaryappendiclediseasescoexistedwithintestinalobstruction,cecalwallfissure,appendicleorileocecallump,withadvantageofsignificantlylowercomplications.[KEYWORDS]Appendectomy;Ileocecum;Tumor;Surgicalindications急性阑尾炎及其周

7、围组织病变的诊断主要依据病史和物理检查，缺少特异的辅助性影像检查，临床误诊率较高。若患者诊治不及时，进一步增加其在诊断和治疗上的难度。在1999〜2008年，在治疗急性阑尾炎时，依据不同复杂情况施行冋盲部或右半结肠切除术共44例，本文分析阑尾手术扩大冋盲部切除在临床应用的指征和疗效，并与讥纯阑尾切除术进行比较和评价，现报道如下。1资料与方法1.1一般资料冋顾性调查普外科1999〜2008年因阑尾疾病行手术治疗的患者122例，男性82例，女性40例，年龄13〜79岁，平均年龄41岁。均无合并其他严重疾病。临床主要表现为发热、右下腹压痛等症状