目的 探讨急性化脓穿孔性阑尾炎术后切口感染的相关因素。方法 回顾性分析2009年1月至2011年6月期间我院普外科手术治疗的化脓穿孔性阑尾炎161例患者的临床资料。结果 161例患者中35例（21.7%）发生了切口感染。单因素分析结果表明，肥胖（体质指数＞30kg/m2）、手术时间超过1h、术前未预防性应用抗生素及术后首次切口换药时间＞3d者切口感染发生率高（P＜0.05）；多因素分析结果表明，手术时间超过1h及术前未预防性应用抗生素是急性化脓穿孔性阑尾炎术后切口感染的独立危险因素（P＜0.05）。结论 早期诊治、降低手术时间、术前合理预防性应用抗生素有助于减少切口感染机会。
目的:分析X线对小儿穿孔性阑尾炎的诊断价值。方法:对经临床手术证实为穿孔性阑尾炎50例的腹部X线平片资料（含12例B超、7例CT资料）作回顾性分析。结果:X线表现为右侧胁腹脂线短缩及腹脂线髂段模糊41例，横结肠充气征43例，小肠积气（小肠环内径≤3 cm）12例、胀气（小肠环内径gt;3 cm）38例，小肠积液50例，小肠壁增厚32例，回盲部密度增高并小气泡影12例，右侧腹腔少量游离气体1例。结论:X线检查对穿孔性阑尾炎有一定诊断价值，结合超声检查和/或CT检查可提高诊断准确率。
目的 探讨急性阑尾炎手术后切口感染的相关因素。方法 观察我院2002年5月至2007年5月期间收治的665例急性阑尾炎患者采用术前预防使用抗生素、术中保护切口、术后加强切口管理等处理后切口感染情况，并分析切口感染与阑尾炎的病程、手术时间、切口选择、留置引流和病理类型之间的关系。结果 本组患者中32例发生切口感染，感染率为4.81% (32/665)，急性阑尾炎术后切口感染与性别无关（ P ＞ 0.05），与病程长短、切口选择、手术时间、腹腔留置引流与否以及病理类型均有关（ P ＜ 0.01）。结论 病程长、手术时间久、炎症较重的急性阑尾炎病例切口感染率较高； 做好围手术期的处理，术中尽量保护切口可以降低切口感染率。
ObjectiveTo further explore and discuss the value of laparoscopic appendectomy. MethodsThe clinical data of 200 patients underwent appendectomy in this hospital from April 2009 to December 2010 were collected. The operation time, postoperative hospital stay, cost of hospitalization, postoperative anal exhaust time, postoperative pain score, and surgical complications were compared between laparoscopic appendectomy and open appendectomy. ResultsThere were 8 cases conversion to the open approach in this series. The cost of laparoscopic appendectomy was higher than that of open appendectomy (Plt;0.05); the cases of chronic appendicitis, acute simple appendicitis, acute suppurative appendicitis within 36 h of onset treated by laparoscopic appendectomy had shorter operation time, shorter postoperative hospital stay, earlier postoperative anal exhaust time, and slighter postoperative pain than those treated by open appendectomy (Plt;0.05); the differences in postoperative hospital stay, postoperative anal exhaust time, postoperative pain of acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis treated by two types of surgery had no statistical significances (Pgt;0.05); the operation time of acute gangrenous appendicitis operated by laparoscopic surgery was longer than that by open appendectomy (Plt;0.05); incision infection rate of laparoscopic appendectomy was lower than that of open appendectomy (Plt;0.05). ConclusionsFor chronic appendicitis, acute simple appendicitis, and acute suppurative appendicitis within 36 h of onset, the outcome and advantages of laparoscopic appendectomy are outstanding, the value of application is clear; and for acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis, laparoscopic appendectomy is difficult and with high rate of conversion, no obvious advantages in recovery after surgery but an increase of medical costs, and the application value is not great.
Objective To investigate the clinical features, diagnosis, and surgical methods of left-sided appendicitis (LSA). Methods We retrieved LSA-related literatures through Pubmed, Google Scholar English databases, Wanfang, CNKI, VIP, and SinoMed databases (published from January 1981 to June 2017), as well as 2 cases of LSA who treated in Beibei Traditional Chinese Medical Hospital, to analyze the clinical characteristics of LSA and its diagnosis and treatment methods. Results There were 92 articles in a total of 212 LSA patients were retrieved, and 2 cases treated in Beibei Traditional Chinese Medical Hospital, a total of 214 LSA patients were included in the analysis. Pain fixed position of LSA: 139 cases (65.0%) located in left-lower quadrant, 30 cases (14.0%) located in right-lower quadrant, 8 cases (3.7%) located in peri-umbilical, 15 cases (7.0%) located in mid-lower abdomen, 15 cases (7.0%) located in left-upper quadrant, 3 cases (1.4%) located in right-upper abdomen, 2 cases (0.9%) located in mid-upper abdomen, 2 cases (0.9%) located in pelvic cavity, respectively. LSA had occurred in association with several types of abnormal anomalies: 131 cases (61.2%) suffered from situs inversus totalis (SIT), 53 cases (24.8%) suffered from midgut malrotation (MM), 21 cases (9.8%) suffered from cecal malrotation, 4 cases (1.9%) suffered from long appendix, 2 cases (0.9%) suffered from free ascending colon, and 3 cases (1.4%) were unclear. The diagnosis of 114 LSA cases (53.3%) before operation was correct, in which the correct diagnosis rates of SIT-LSA and MM-LSA were 74.8% (98/131) and 22.6% (12/53), respectively. Three patients (1.4%) underwent conservative treatment, and 211 patients (98.6%) underwent surgical treatment, including 25 cases (11.7%) of laparoscopic surgery, 145 cases (67.8%) of open abdominal surgery, and unknown of 41 cases (19.1%). Laparotomy incision: abdominal incision in 74 cases (51.0%), ventral midline incision in 16 cases (11.0%), the left side of the anti McBurney incision in 43 cases (29.7%), right McBurney incision in 12 cases (8.3%). Conclusions LSA mainly occurs in association with 2 types of congenital anomalies: SIT and MM. There is some difficult to make diagnosis for abnormal anatomy and inaccurate pain location of LSA, so it is easy to cause the delay in diagnosis or misdiagnosis. For LSA, the choices of laparoscopy or laparotomy operation methods are applicable.
目的:分析不典型阑尾炎的CT表现特点,以提高对其诊断和鉴别诊断。方法:临床表现不典型的阑尾炎17例,对CT表现进行重建及分析。结果:单纯阑尾增粗有8例,增粗并结石2例,阑尾周围脓肿5例,阑尾合并肠套叠肠梗阻1例,阑尾周围脓肿并广泛盆腔炎1例。结论: 16 MSCT对不典型阑尾炎的诊断有较高的临床应用价值。
截止至2002年6月,有关阑尾炎治疗的临床证据如下:①辅助性抗生素治疗:1项RCT和1项回顾性RCT发现,经阑尾切除术的复杂性和单纯性阑尾炎的成人和儿童,预防性使用抗生素可显著减少伤口感染和腹腔内脓肿.②辅助性抗生素治疗(儿童复杂性阑尾炎):1项系统评价的亚组分析发现,使用抗生素可显著减少伤口感染.③辅助性抗生素治疗(儿童单纯性阑尾炎):1项系统评价的亚组分析发现,使用抗生素不减少伤口感染.1项儿童单纯性阑尾炎的回顾性RCT发现,预防性使用抗生素不能减少伤口感染,但该RCT的样本量太小,不能排除有临床差别.④抗生素治疗和手术:1项成人疑诊阑尾炎的RCT发现,与手术治疗比较,抗生素保守治疗可减少治疗开始后12 h到10 d的疼痛和吗啡的使用.但采取抗生素保守治疗的患者有35%在1年内再次因急性阑尾炎入院,并行阑尾切除术.⑤腹腔镜手术和开腹手术(成人):1项系统评价发现,腹腔镜手术可以减少伤口的感染,减轻手术后第1天的疼痛,减少住院时间以及恢复工作的时间,但增加手术后腹腔内脓肿的发生.⑥腹腔镜手术和开腹手术(儿童):1项系统评价发现,腹腔镜手术可以减少伤口的感染,减少住院时间,但不能减轻手术后第1天的疼痛,不能减少恢复的时间和腹腔内脓肿的发生.⑦开腹手术和不治疗:无RCT证据.⑧开腹阑尾切除术中对残端的内翻处理:1项RCT发现,两次包埋和单纯结扎比较,不能减少伤口的感染、住院时间和腹腔内脓肿的发生.