作者：黄家荣1，缪锦超1，刘赞伟1，施珊格1，林晓锋1，黄素梅1，蔡世春1，叶锦宁2

单位：1.广东医科大学附属彭湃纪念医院，广东 海丰 516400； 2. 中山大学附属第一医院胃肠外科中心，广东 广州 510080

Authors:  HUANG Jiarong1, MIAO Jingchao1, LIU Zanwei1, SHI Shange1, LIN Xiaofeng1, HUANG Sumei1, YE Jinning2

Unit:  1.Department of General Surgery, Pen-pai Memorial Hospital, Shanwei 516400, Guangdong, China; 2.Department of Gastrointestinal surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China

摘要：

目的  比较不同病理类型阑尾炎的临床特征及疗效。方法  自2010年9月至2012年9月间接受手术治疗并术后病理证实的急性阑尾炎452例,±术中探查及术后病理结果分为单纯组(67例)、化脓组(265例)、坏疽组(70例)、穿孔组(50例),比较各组临床特征及疗效。结果  各组间性别、居住地、典型体征相比差异无统计学意义(均P>0.05)。单纯组、化脓组、坏疽组、穿孔组的中位年龄M(Q1,Q3)(岁)分别为29(20,45)、28(19,43)、35(20,47)、41(18,66),穿孔组显著升高(P<0.05);病程M(Q1,Q3)(hr)分别为24 (11,48)、22 (11,24)、48 (21,48)、48 (20,54),化脓组最短(P<0.05);中毒症状为主者分别占0%、6.0%、5.7%、20.0%,合并内科疾病史者分别占16.4%、13.6%、20.0%、36.0%,穿孔组均最高(均P<0.05)。术前白细胞计数WBC (×109/L) M (Q1,Q3)分别为11.5 (8.5,14.1)、13.1(11.3,15.8)、13.9(10.6,11.7)、13.4(10.9,15.9),单纯组最低(P<0.05);术前B超右下腹包块者分别占19.4%、21.1%、41.4%、26.0%,坏疽组最高(P<0.05);腹腔积脓者分别占26.9%、43.0%、52.9%、16.0%,化脓组、坏疽组较其他两组显著升高(P<0.05);切口长度M (Q1,Q3)(cm)分别为5 (4,7)、5 (4,6)、6(5,7)、6(5,6),坏疽组和穿孔组显著延长(P<0.05);各组手术时间M(Q1,Q3)(min)分别为35(25,50)、40 (30,50)、50 (45,60)、60 (48,81),组间差异有统计学意义(P <0.05)。各组腹腔引流者分别占0%、0%、0%、10%,术后平均排气时间(d)分别为1.0±0.2、1.0±0.1、1.0±0.1、1.2±0.7,术后进食时间(d)分别为1.0±0.0、1.0±0.0、1.0±0.0、1.2±0.7,术后平均拆线时间(d)分别为7.0±0.0、7.0±0.0、7.0±0.0、7.1±0.4,术后平均体温正常时间(d)分别为1.0±0.1、1.1±0.4、1.1±0.4、1.5±0.6,术后平均WBC正常时间M(Q1,Q3)(d)分别为3 (2,5)、3 (2,4)、3 (2,5)、4 (3,6),术后切口感染率分别为0%、0%、1.4%、8.0%,穿孔组均最高(均P<0.05)。各组术后平均住院时间(d)分别为6.6±2.1、6.6±1.5、7.6±4.6、8.2±2.9,坏疽组与穿孔组显著延长(P<0.05)。结论  各类型阑尾炎相比,穿孔性阑尾炎发病年龄升高、合并内科病病增多、容易出现全身中毒表现、治疗效果较其他类型显著不良。化脓性阑尾炎和坏疽性阑尾炎容易出现腹腔积脓,且坏疽性阑尾炎容易出现腹部包块。各类型阑尾炎无发生时间上的序贯性。

关键词： 急性阑尾炎; 临床病理; 疗效; 手术治疗

Abstract：

Objective  To compare the clinical features and therapeutic effect of different type of acute appendicitis. Methods  All 452 cases of acute appendicitis undergoing surgical treatment (from September 2010 to September 2012) were categorized into the 4 groups based on surgical and pathological findings, simple(n=67), suppurative(n=265), gangrenous(n=70) and perforated appendicitis(n=50). The clinical features and therapeutic effect were compared in different groups. Results  No significant difference had been found in 4 groups in gender, place of residence, typical signs and symptoms(all P＞0.05). In cases of simple, suppurative, gangrenous and perforated groups, the median age M(Q1,Q3)(yr) was 29(20,45) vs.28(19,43) vs. 35(20,47) vs. 41(18,66), symptoms duration M(Q1,Q3)(hr)was 24(11,48) vs. 22(11,24) vs. 48(21,48) vs. 48(20,54), ratio of priority to toxic symptoms was 0% vs. 6.0% vs. 5.7% vs. 20.0%, ratio of combined with medical diseases was 16.4% vs. 13.6% vs.20.0% vs. 36.0%, all with significant difference among groups(all P＜0.05). In 4 groups, preoperative WCC(white blood cell counting)(x10⁹/L) M(Q1,Q3) was 11.5(8.5,14.1) vs. 13.1(11.3,15.8) vs. 13.9(10.6,11.7) vs. 13.4(10.9,15.9), ratio of right lower quadrant enclosed mass under preoperative ultrasound was 19.4% vs. 21.1% vs. 41.4% vs. 26.0%, ratio of pyocelia was 26.9% vs. 43.0% vs. 52.9% vs. 16.0%, incision length M(Q1, Q3)(cm)was 5(4,7) vs. 5(4,6) vs. 6(5,7) vs. 6(5,6), operation duration M(Q1, Q3)(min) was 35(25,50) vs. 40(30,50) vs. 50(45,60) vs. 60(48,81),ratio of undergoing celiac drainage was 0% vs. 0% vs. 0% vs. 10%, the mean first postoperative evacuation time(d)was 1.0±0.2 vs. 1.0±0.1 vs. 1.0±0.1 vs. 1.2±0.7, the mean first time to take food postoperativly (d) was 1.0±0.0 vs. 1.0±0.0 vs. 1.0±0.0 vs. 1.2±0.7, the mean time(d) of removing stitches was 7.0±0.0 vs. 7.0±0.0 vs. 7.0±0.0 vs. 7.1±0.4, the mean time (d) of postoperative normothermia was 1.0±0.1 vs. 1.1±0.4 vs. 1.1±0.4 vs. 1.5±0.6, the median time of WCC normally M(Q1, Q3)(d)was 3(2,5) vs. 3(2,4) vs. 3(2,5) vs. 4(3,6), incisional infection rate was 0% vs. 0% vs. 1.4% vs. 8.0%, postoperative average stay(d)was 6.6±2.1 vs. 6.6±1.5 vs. 7.6±4.6 vs. 8.2±2.9, all with significant difference among groups (all P＜0.05). Conclusions  In different type of acute appendicitis, perforated appendicitis with oldest age and highest ratio of combing medical disease, systemic poisoning symptoms, and poorest therapeutic effect. Suppurative and gangrenous appendicitis easy to produce pyocelia, and gangrenous appendicitis with highest ratio of abdominal mass. No Sequential relationship had been found in different type of acute appendicitis.

Key Words:  Acute appendicitis; Pathology, Clinic; Therapeutic effect; Surgical treatment