中国普外基础与临床杂志

中国普外基础与临床杂志

左侧阑尾炎的临床分析(附 2 例报道及 212 例文献复习)

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目的 总结左侧阑尾炎(left-sided appendicitis,LSA)的临床特点及诊治方法。 方法 计算机检索 Pubmed、Google Scholar、万方、中国知网、维普及 SinoMed 数据库中的 LSA 相关文献(检索时间为 1981 年 1 月至 2017 年 6 月),结合重庆市北碚区中医院收治的 2 例 LSA 病例,总结 LAS 的临床特征及其诊治策略。 结果 共检索到 92 篇文献,共计 212 例 LSA 患者,联合笔者收治的 2 例,共计 214 例 LAS 患者纳入分析。疼痛固定部位:左下腹 139 例(65.0%),右下腹 30 例(14.0%),中下腹及左上腹各 15 例(7.0%),脐周 8 例(3.7%),右上腹 3 例(1.4%),中上腹及盆腔各 2 例(0.9%)。解剖结构异常分类:全内脏反位(situs inversus totalis,SIT)131 例(61.2%),肠旋转不良(midgut malrotation,MM)53 例(24.8%),盲肠游离 21 例(9.8%),阑尾过长 4 例(1.9%),升结肠游离 2 例(0.9%),其他 3 例(1.4%)。术前正确诊断 LSA 114 例(53.3%),其中术前正确诊断为 SIT 型 LSA 98 例(74.8%,98/131),正确诊断为 MM 型 LSA 12 例(22.6%,12/53)。3 例(1.4%)行保守治疗,211 例(98.6%)行手术治疗,术式:腹腔镜切除 25 例(11.7%),开腹手术 145 例(67.8%),不详 41 例(19.1%);开腹手术切口:腹直肌旁切口 74 例(51.0%),腹正中线切口 16 例(11.0%),左侧反麦氏点切口 43 例(29.7%),右侧麦氏点切口 12 例(8.3%)。 结论 LSA 的解剖异常主要以 SIT 和 MM 为主,异常的解剖结构及不准确的疼痛定位使 LSA 的诊断存在一定的困难,容易导致延迟诊断或误诊。腹腔镜手术或剖腹探查手术是 LSA 较为适用的手术方式。

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.

关键词: 左侧阑尾炎; 全内脏反位; 肠旋转不良; 盲肠游离; 文献回顾

Key words: left-sided appendicitis; situs inversus totalis; midgut malrotation; cecal malrotation; literature review

引用本文: 罗云, 吴定泉, 朱长康, 王崇树. 左侧阑尾炎的临床分析(附 2 例报道及 212 例文献复习). 中国普外基础与临床杂志, 2018, 25(5): 572-577. doi: 10.7507/1007-9424.201710066 复制

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