内镜下逆行阑尾炎治疗术的手术技巧及效果分析
Analysis of operative skills and effects of endoscopic retrograde appendicitis therapy

摘要：目的 研究内镜下逆行阑尾炎治疗术(ERAT)治疗急性非复杂性阑尾炎的手术技巧及手术效果。方法 将2014年10月至2015年1月我院收治的21例拟诊为急性阑尾炎患者纳入研究，急诊行ERAT，分析ERAT手术技巧与治疗效果之间的关系。结果 患者均顺利完成ERAT手术，无1例转外科手术治疗。ERAT平均手术时间为(49.7±18.2)min，患者平均住院时间(3.3±1.6)d。阑尾腔插管作为ERAT最关键的步骤，使用带圈导丝明显缩短插管时间，平均(5.7±4.9)min(P<0.05)。14例患者伴有阑尾粪石(7例块状粪石，4例碎渣样粪石，3例碎渣样粪石伴阑尾腔狭窄)，均以取石球囊或网篮成功取出，取石成功率100%。取石网篮取出巨大阑尾粪石并发阑尾穿孔1例，经保守治疗痊愈。放置阑尾支架9例，1周后于门诊行结肠镜取出，均未出现由支架引起的不适或相关并发症。ERAT手术时间随术者手术例数的增多而逐渐缩短。结论 ERAT是一种安全、有效的治疗急性非复杂性阑尾炎的内镜治疗方法。选择合适的插管、取石工具，适时放置阑尾支架，增加操作例数等措施将有效地提高手术成功率和安全性。
ABSTRACT: Objective To study the skills and effects of endoscopic retrograde appendicitis therapy (ERAT) in treating patients with uncomplicated acute appendicitis. Methods We enrolled 21 patients with suspected acute appendicitis who then underwent emergent ERAT between October 2014 and January 2015. The data of treatment were collected and the operative skills and effects of ERAT were analyzed. Results ERAT was completed successfully in all the patients, resulting in a success rate of 100%. Mean operation time of ERAT was (49.7±18.2)min and mean hospital stay was (3.3±1.6)d. Cannulation of the appendix lumen was the most critical step of ERAT, and cannulation time [(5.7±4.9)min, P<0.05] was shortened significantly by the use of LoopTip guidewire. Fourteen patients with intraluminal appendicoliths (7 of massive appendicoliths, 4 of sand-like appendicoliths and 3 of sand-like appendicoliths with luminal stenosis) underwent endoscopic lithotomy successfully with balloon or basket, with the success rate of 100%. One patient who presented perforation after appendicolith removal by basket was cured with conservative treatment. Appendix stent was inserted, then pulled out after 1 week in 9 patients, while no complaint or complication of the stent was observed. Operation time of ERAT shortened with the increase of case number. Conclusion ERAT is an effective and safe therapy for treating patients with uncomplicated acute appendicitis. The high success rate and safety of ERAT will be achieved by selecting suitable instruments for cannulation and appendicolith removal, deciding suitable indications for stenting, and accumulating of operative cases