阑尾周围脓肿的Ⅰ期手术治疗_64576
阑尾周围脓肿的?期手术治疗
[标签:来源]
【摘要】 目的 探讨急性阑尾周围脓肿?期手术切除的指征、方法和并发症。方法 对
1990年1月,2005年12月收治的行?期手术治疗的276例急性阑尾周围脓肿患者的病例资
料进行分析。结果 本组276例无围手术期死亡。发生切口感染27例,腹壁窦道形成3例,
盲肠瘘2例,腹腔残余脓肿1例。平均住院天数15.8天。结论 急性阑尾周围脓肿不是I期
手术治疗的禁忌证,积极采取合适的手术方式能及早控制炎症,缩短病程。但要视术中具体
情况,不能盲目追求I期切除率。
【关键词】 阑尾周围脓肿;手术
Operation of appendiceal abscess in initial stage
FAN Jun,BI Yong-lin,XING Guang-fu.
Department of General Surgery,Shanghai No.8 Peoples Hospital,Shanghai 200235,
China
【Abstract】 Objective To explore operation signs,techniques and complications
of appendiceal abscess.Methods From January 1990 to December 2005,276 cases that
were removed in initial stage were analyzed.Results Among 276 cases,no case was
died.27 cases had wound infection.3 cases had sinus tract of abdominal wall.2 cases had leakage of cocum.1 case had intra abdominal abscess.The average time in hospital is 15.8 days.Conclusion Removal of appendix in initial stage is no longer forbidden to acute appendiceal abscess patients.An active proper operation technique can control inflammation and reduce course of disease.We must accord the fact in operation and can not blindly increase the rate of appendix removal in initial stage.
【Key words】 appendiceal abscess;operation
阑尾周围脓肿是急性阑尾炎较严重的病理类型,其发生率约8%,一般均采用非手术的综
合治疗,1,。我院1990年1月,2005年12月间收治急性阑尾炎病例共5640例,其中阑尾
周围脓肿302例(5.35%),对276例阑尾周围脓肿患者行?期手术治疗,取得了较好的疗效,
现报告如下。
1 资料与方法
1.1 一般资料 本组276例中男198例,女78例,男女比例为2.54?1;年龄16,89岁,平均,,(,岁。病程4,14天,平均8.5天,病程4,6天232例,?7天44例。所有病人均有右下腹痛、发热、右下腹包块,血象增高,入院后经,超检查确诊。
1.2 手术方法 麻醉一般选择连续硬膜外麻醉即可。行麦氏切口78例,经腹直肌切口198例。进腹后用纱布棉垫保护周围脏器,钝性分离脓肿,吸尽脓液,脓液量50,300ml不等,切除阑尾及包裹肿块的大网膜组织。阑尾腔内有粪石者205例,直径0.5,2.0;,。阑尾根部尚完好者常规荷包缝合包埋,根部无法结扎包埋者用,号丝线在阑尾根部盲肠壁上间断缝合浆肌层,并用临近系膜或皱襞组织覆盖。术后用甲硝唑溶液冲洗脓腔,常规放置乳胶管或烟卷引流,切口皮下放置皮片引流。
2 结果
本组276例无围手术期死亡。发生切口感染17例(6.16%),腹壁窦道形成3例(1.09%),盲肠瘘2例(0.72%),腹腔残余脓肿1例(0.36%)。平均住院天数15.8天。