吕孟?邹文贵?张伟?方骏?黎海怡

【摘要】 目的 探讨分析粪石性阑尾炎合并回盲部穿孔的手术方式。方法 回顾性分析5例粪石性阑尾炎合并回盲部穿孔患者的临床资料， 其中本院首次手术3例；外院手术后转入本院继续治疗2例。结果 本院手术患者因术中即发现合并回盲部穿孔， 及时手术处理后无一例并发症发生。外院转入患者经过再次手术后， 均治愈出院。结论 粪石性阑尾炎， 尤其是腹膜后位、回肠后位、盲肠后位及外侧位的粪石性阑尾炎很容易合并回盲部穿孔， 所以术中如发现是腹膜后位、回肠后位、盲肠后位及外侧位的粪石性阑尾炎， 一定要探查确定是否存在回盲部的穿孔， 若粪石所在部位阑尾已经穿孔一定要找到粪石， 才能有效减少术后肠瘘、腹腔脓肿等不必要的术后并发症。

【关键词】 急性阑尾炎；粪石性阑尾炎；阑尾切除术；回盲部穿孔；肠瘘；腹腔脓肿

DOI：10.14163/j.cnki.11-5547/r.2016.08.017

Investigation and analysis of surgical measures for stercoral appendicitis complicated with ileocecal perforation LYU Meng， ZOU Wen-gui， ZHANG Wei， et al. Department of General Surgery， Honghe State Diannan Central Hospital/Fifth Affiliated Hospital of Kunming Medical University， Gejiu 661000， China

【Abstract】 Objective To investigate and analyze surgical measures for stercoral appendicitis complicated with ileocecal perforation. Methods Clinical data of 5 patients of stercoral appendicitis complicated with ileocecal perforation were retrospectively analyzed. There were 3 cases received their first operation in our hospital， and the other 2 cases were transferred into our hospital for further treatment. Results Intraoperative detection of ileocecal perforation in the 3 cases provided successful operation， without any complications. Transferred cases were cured after second operation and discharged from hospital. Conclusion It is easy for stercoral appendicitis， especially retroperitoneal， ileum， cecum and outside stercoral appendicitis， to be complicated with ileocecal perforation. Therefore， detection of ileocecal perforation is necessary during operation for stercoral appendicitis. Detection of stercorolith after perforation is essential to reduce postoperative complications of intestinal fistula and abdominal abscess

【Key words】 Acute appendicitis； Stercoral appendicitis； Appendicectomy； Ileocecal perforation； Intestinal fistula； Abdominal abscess

阑尾切除手术技术已经非常成熟， 也是住院医师应该熟练掌握的基本手术， 在很多医院也是外科医师最先开始接触的基本手术。但每年因为行阑尾切除术而产生并发症导致患者长期住院治疗， 二次手术等， 都给患者带来巨大心理和经济负担。如果能在手术中注意经验的积累和手术技巧的改善， 在让自己诊治的患者获益的同时， 也使自己的医学素养、业务水平和综合素质得到提升。粪石性阑尾炎起病突然， 病情发展快， 早期易发生化脓、坏疽甚至穿孔[1， 2]。本文回顾分析本院收治的粪石性阑尾炎患者中合并回盲部穿孔的病例共5例， 其中本院首次手术的病例3例， 外院手术后因未发现回盲部穿孔导致肠瘘、腹腔脓肿形成， 转入本院继续治疗病例2例。……