Treaing 27 Patients’ Periappendiceal Abscess through Endoscopic Appendiceal Stent Internal Drainage
Abstract: 目的：探讨经内镜阑尾支架内引流治疗阑尾周围脓肿的临床价值及安全性。方法：收集2017年4月~2018年10月内蒙古医科大学乌海市中医院微创中心收治的27例阑尾周围脓肿患者，经内镜阑尾支架内引流治疗，动态观察患者引流治疗前及治疗后1、3、5天体温、血白细胞(white blood cell, WBC)、C反应蛋白(C-reaction protein, CRP)、脓肿大小变化，统计患者腹痛缓解及消失的时间、术后住院时间及医疗费用。结果：所选病例经内镜给予生理盐水反复冲洗后，置入阑尾支架(10Fr塑料支架)，对其中9例发现阑尾粪石性梗阻患者，经内镜使用取石网篮取石成功后，予以支架置入。术后患者腹痛缓解明显，体温、WBC及CRP均下降明显，住院时间短。随访2年，1例患者复发阑尾炎，行腹腔镜下阑尾切除术后痊愈。结论：结肠镜下治疗阑尾周围脓肿是安全、有效的，合并阑尾腔内梗阻的患者同时解除阑尾腔梗阻效果更加明显。 Objective: To investigate the clinical application value and safety of treatment for patients about endoscopic appendiceal stent drainage in the treatment of periappendiceal abscess. Methods: To collected cases from April 2017 to October 2018, 27 patients who suffer from a disease. The disease is called periappendiceal abscess, which is a complication of acute appendicitis that occurs without treatment. The pathogenesis of the disease is the formation of inflammatory pus around the appendix, followed by the surrounding omentum surrounding the pus, the formation of abscess around the appendix. These cases admitted to research group, were chosen by the minimally invasive surgery center of Wuhai Hospital of traditional Chinese medicine of Inner Mongolia Medical University, were treated with endoscopic appendiceal stent drainage. The changes of related indexes after operation were observed dynamically. Those indexes include temperature changes, white blood cell (WBC) count, C-reaction protein (CRP) changes and abscess size were dynamically observed before and 1, 3 and 5 days after treatment that the cases periappendiceal abscess treated by endoscopic appendiceal stent internal drainage, and the time when abdominal pain begin to ease and disappear completely, duration of hospital stay after treatment, and the total cost of the medical procedure. Results: The selected cases were rinsed repeatedly with sterile water for in-jection by endoscopy, and then the stent (10Fr plastic stent) was inserted along the opening of the appendix. Among them, 9 patients were found the fecaliths is confined to the appendix cavity which causes poor drainage of the appendix. The fecaliths were successfully removed by endoscopic lithotripsy basket in the process of the treatment, and then the stent was placed along the opening of the appendix. After operation, the patients felt abdominal pain was significantly and rapidly relieved. The change of body temperature was monitored, which was found that the body temperature dropped quickly and then returned to normal. Inflammatory markers such as WBC and CRP decreased significantly. The length of hospital stay was short. The abdominal abscess was significantly reduced by B-ultrasonography after surgery 5 days. All 27 patients were followed-up for two years. One of all the patients who received the treatment that endoscopic appendiceal stent drainage in the treatment of periappendiceal abscess case, who had acute appendicitis again, then cured after underwent laparoscopic appendectomy. Conclusion: Periappendiceal abscess treated by endoscopic appendiceal stent internal drainage is safe and effective. And the results are even better and more significant in patients with obstruction of appendiceal cavity.
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