摘要
目的初步探讨内镜下逆行支架置入术治疗急性阑尾炎的可行性、有效性、复发率及并发症等情况。方法分析临床诊断急性阑尾炎的7例患者,按以下步骤进行治疗:(1)生理盐水高位清洁灌肠2～3次;(2)内镜下冲洗回盲部,观察阑尾开口处情况;(3)造影管引导下将导丝置入阑尾口,造影显像;(4)甲硝唑反复冲洗;(5)置入阑尾支架,引流炎性分泌物并冲洗;(6)术后观察腹痛、发热、排便等情况;(7)2周后肠镜复查、取出支架。所有患者手术前2h至术后48h均使用抗菌药物治疗。术后8～15个月进行随访评估。结果在7例患者中,4例患者成功置入阑尾支架并引流,术后患者腹痛明显缓解,白细胞(WBC)水平在术后24～48h恢复正常。出院后半个月2例患者行阑尾支架取出术,术中见阑尾开口黏膜光滑,2例患者支架自行脱出,复查见阑尾开口形态正常。术后随访8～15个月,1例患者复发,并至普外科行手术治疗。另3例患者因插管不成功未行阑尾支架置入术。结论内镜下支架置入术治疗急性阑尾炎具有创伤小、疗效显著等特点,但仍需大规模多中心随机对照临床试验研究以科学地评估其可行性及远期疗效。
Objective To explore the feasibility ,effectiveness ,recurrence rate and complications ,etc .of endoscopic retrograde stenting in treating acute appendicitis .Methods A retrospective analysis was conducted on seven patients with the clinical diagnosis of acute appendicitis ,complying with the following treatment steps ：（1） normal saline for high cleansing enema in 2-3 times ;（2） en-doscopically douching ileocecal junction and observing the opening of appendix ;（3） placing the guide wire into the opening of appen-dix under the guidance of imaging tube ,and then conducting angiography imaging ;（4） repeatedly douching with metronidazole;（5） implant the appendix stent ,draining the inflammatory secretions out and then douching ;（6 ） observing postoperative abdominal pain ,fever ,bowel and other conditions;（7） reviewing with the enteroscopy and removing the stent 2 weeks later .At 2 before the surgery and 48 after it ,all patients were administrated with antibiotics for anti-infective treatment .The follow-up was made from 8-15 months after the surgery .Results Among these 7 patients ,4 patients had successful appendix stenting ：the abdominal pain sig-nificantly alleviated after the surgery ;the proportional level of white blood cells（WBC）recovered during 24-48 after the surgery .15 after discharge ,two patients returned to hospital and their appendix stent removal was successful;during the operation ,smooth mu-cosa at the opening of appendix was observed .The stents of two patients spontaneously fell off ,and normal morphology of the ap-pendix opening was observed at review .During the postoperative follow-up of 8-15 months ,one patient relapsed and underwent sur-gical treatment in the general surgery department .The other three patients did not undergo appendix stenting due to the unsuccess-ful intubation .Conclusion The treatment of acute appendicitis with endoscopic stenting has the advantages of little trauma ,high safety and significant efficacy .However ,this method still requires large-scale and multicenter randomized controlled clinical trials to evaluate its feasibility and long-term efficacy .
出处
《重庆医学》
CAS
CSCD
北大核心
2014年第29期3882-3884,共3页
Chongqing medicine
