老年人急性阑尾炎的腹腔镜手术治疗

目的 探讨老年人急性阑尾炎的临床特点，更好地把握腹腔镜阑尾切除（LA）术的方法和特点。方法 回顾分析50例老年人急性阑尾炎LA的临床资料。结果 LA均获成功，患者全部治愈，无严重的并发症发生，肠功能恢复时间及住院时间均缩短。结论 老年人反应迟钝，阑尾炎进展快，易发生坏疽及穿孔，合并症多，手术风险较高，LA是安全、可行的，除个别腹膜后阑尾炎外，其余均可施行LA。     

LAPAROSCOPIC TREATMENT FOR PERFORATED APPENDICITIS WITH PELVIC ABSCESS

We performed laparoscopic appendectomy and drainage to treat panperitonitis due to perforated appendicitis that occurred in a 28‐year‐old woman. We believe this is an appropriate procedure to treat perforated appendicitis because it is safe and minimally invasive, and faster recovery can be expected than after conventional open appendectomy.     

Risk of appendiceal neoplasm after interval appendectomy for complicated appendicitis: A systematic review and meta-analysis

BackgroundNon-operative management is often the treatment of choice in cases of complicated appendicitis and routine interval appendectomy is not usually recommended. Actually, recent studies show an alarming number of appendiceal neoplasms following interval appendectomy. The aim of this study is to evaluate the prevalence of appendiceal neoplasms and their histological types after interval appendectomy for complicated appendicitis in adults.MethodsA comprehensive literature search of the PubMed, Scopus and Web of Science databases was conducted according to the PRISMA statement. Studies reporting appendiceal neoplasm rates after interval appendectomy and histopathological characteristics were included. The most recent World Health Organization (WHO) classification of malignant tumours was considered. A pooled prevalence analysis for both prevalence and pathology was performed.ResultsA total of eight studies was included: seven retrospective series and one randomized controlled trial. The pooled prevalence of neoplasms after interval appendectomy was 11% (95% CI 7–15; I² = 37.5%, p = 0.13). Appendiceal mucinous neoplasms occurred in 43% (95% CI 19–68), adenocarcinoma in 29% (95% CI 6–51), appendiceal neuroendocrine neoplasm in 21% (95% CI 6–36), globet cell carcinoma in 13% (95% CI -2-28), adenoma or serrated lesions in 20% (95% CI -0-41) of cases.ConclusionThe risk of appendiceal neoplasm in patients treated with interval appendectomy for complicated appendicitis is 11%; mucinous neoplasm is the most common histopathological type. Further studies should investigate this association in order to clarify the biological pathway and clinical implications.     

Die laparoskopische appendektomie Eine literaturrecherche

Zusammenfassung Laparoskopische Operationsmethoden gewannen in den vergangenen Jahren zunehmende Popularität in der Chirurgie. Die laparoskopische Cholezystektomie gilt inzwischen als etabliert. Im Gegensatz dazu ist die laparoskopische Appendektomie weiterhin umstritten. Mittels der computergestützten Literaturdatenbank Medline wurden sämtliche Veröffentlichungen bis zum 31.12.1993 zum Stichwort laparoskopische Appendektomie zusammengetragen. Von 90 Publikationen stellen lediglich 14 einen Vergleich zwischen konventioneller und laparoskopischer Appendektomie an. Lediglich zwei prospektiv randomiserte Studien wurden publiziert. Die geringen Kollektivgrößen lassen eine abschließende Bewertung der laparoskopischen Methode noch nicht zu.

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Laparoscopic appendectomy — a review

Laparoscopic methods are becoming increasingly popular in surgery. In the course of a review concerning laparoscopic appendectomy undertaken up to 31 December 1993 all publications were evaluated by computer-assisted recherche. Out of a total of 90 publications only 14 deal with the comparison of the laparoscopic versus open appendectomy. Two prospective randomized studies are published. Because of the low number of patients the evaluation of the laparoscopic method is not yet definite.

     

Appendicitis: Higher risk in Mexican Americans?

Objectives. Mexican Americans (MAs), compared to white non‐Hispanics (WNHs), have higher rates of biliary disease, noninsulin dependent diabetes, and endstage renal disease but lower rates of lung cancer, hip fractures, and mortality from coronary heart disease. Relatively little research has been done to identify other ethnic differences in disease incidence. We used surgical procedure rates to confirm known ethnic differences and to explore our clinical suspicion that MAs have higher rates of appendectomy than WNHs.

Methods. We used a registry of surgical procedures at two teaching hospitals in South Texas to calculate proportional operation ratios (PORs) for MAs versus WNHs. These two hospitals are the primary source of acute hospital care for the indigent in the area. The POR is arithmetically identical to proportional incidence and mortality ratios.

Results. MAs underwent appendectomy proportionally more often than WNHs at both hospitals (POR = 1.41 and 1.75, p < 0.0001). Other significant PORs were consistent with known ethnic disease differences in biliary tract operations, vascular access for chronic hemodialysis, lung cancer, and coronary artery bypass.

Conclusions. These findings support the hypothesis that MAs may undergo appendectomy more often than WNHs and so may be at higher risk of appendicitis.     

Cancer risk following appendectomy for acute appendicitis (Denmark)

Objective: Epidemiologic studies have not been able definitely to exclude that appendectomy carries a cancer risk. This study was conducted to clarify whether appendectomy is associated with a subsequent increase in cancer risk, since appendectomy is frequently an elective procedure. Methods: The present study included more than 82,000 persons who underwent appendectomy for acute appendicitis during 1977-89 according to the nation-wide Danish Hospital Discharge Register. During a follow-up interval of up to 17 years, cancer incidence was assessed by linkage to the Danish Cancer Registry and compared with the incidence in the general population of Denmark. Results: The total number of malignancies among appendectomized persons was 1.05 times higher than expected with 95 percent confidence intervals of 0.99-1.11. There was no clear significant excess of any specific cancer type. Conclusion: During a postsurgery period of nearly two decades, results of our study did not support the hypothesis that either appendectomy or acute appendicitis are likely to be associated with malignant neoplasms.     

急性阑尾炎行腹腔镜手术与开放手术的对比分析

目的对比急性阑尾炎经腹腔镜切除(LA)与传统开腹切除(OA)的手术效果及优缺点。方法回顾性分析我院2004年10月—2007年10月160例急性阑尾炎(LA组80例,OA组80例)的手术情况,并对其临床资料进行统计、对比、分析。结果LA与OA的手术时间无显著性差异,LA术后疼痛程度、术后住院时间、术后切口感染等方面明显优于OA。结论LA是安全可靠的,与OA相比,具有创伤小、恢复快、并发症少和住院时间短的优势,可作为急性阑尾炎的首选手术方式。     

阑尾小切口与腹腔镜下阑尾切除术的比较

目的观察开腹小切口与腹腔镜阑尾手术效果。方法回顾性分析2007年5月至2011年5月112例小切口阑尾及142例腹腔镜阑尾。结果阑尾小切口费用少,术后并发症少。结论开腹小切口阑尾在费用及术后并发症方面有明显的优势。     

阑尾切除后再手术15例分析

目的　探讨由于误诊、误治致阑尾切除术后再手术的原因。方法　对 1992年 3月～ 2 0 0 4年 4月因误诊、误治导致阑尾切除术后再手术 15例进行回顾性分析。结果　因误诊、误治导致阑尾切除术后再手术 15例。再次手术后全部治愈。结论　遵循外科基本原则 ,掌握外科基本功 ,常能避免或减少阑尾炎再手术的机会     

Laparoscopic management of a nonobstetric emergency in the third trimester of pregnancy

Background Laparoscopic management of nonobstetric acute abdominal pain during pregnancy remains controversial. A gestational age of 26 to 28 weeks has been considered the upper limit for laparoscopy by some authors. A case series of nonobstetric surgery in advanced pregnancy is reported. Methods Third-trimester patients who underwent surgery between 1997 and 2006 were reviewed. Results Laparoscopic surgery was performed for nonobstetric emergencies during the third trimester for 11 patients. Four patients underwent open surgery. The laparoscopic surgery group included five cholecystectomies, four appendectomies, and two adenexal surgeries. The laparoscopic surgery procedure was successfully completed for 10 patients. Of these 10 patients, 9 had no complications and went on to deliver a healthy term infant. One patient went into preterm labor after a laparoscopic appendectomy for perforated acute appendicitis with purulent peritonitis and delivered a viable infant at 34 weeks. Another patient at 29 weeks of gestation underwent a diagnostic laparoscopy for abdominal pain. Adenexal torsion of a large multicystic ovarian mass led to a laparotomy (obstetrician preference) and right salpingo-oophrectomy. Her postoperative course was complicated by an episode of sudden syncope, hypotension, and fetal distress on postoperative day 3. An emergent laparotomy showed hemoperitoneum attributable to bleeding from the ovarian pedicle. A cesarean section delivery of a preterm infant requiring neonatal resuscitation was performed. The open surgery group included four patients. Two of the patients underwent appendectomies at 35 and 33 weeks, respectively, followed by a term delivery. The remaining two patients underwent emergent colectomies with a cesarean section delivery at 31 and 38 weeks, respectively. Conclusions This study demonstrated that laparoscopic surgery in the third trimester of pregnancy is feasible and can be performed safely with an acceptable risk to the fetus and the mother. Access to the pregnant abdomen is easily obtained. Space generally is not a problem, and there is minimal uterine manipulation. Paper presented at the Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Dallas, Texas, USA, April 2006