范峰+康涛+陆耀良

[摘要]目的 总结盲肠憩室炎的诊断和治疗经验。方法 回顾性分析苏州大学附属太仓医院2011年7月～2017年2月收治的34例盲肠憩室炎的临床资料，所有患者均表现为急性右下腹疼痛。术前腹部CT确诊盲肠憩室炎23例，误诊为急性阑尾炎10例，误诊为阑尾脓肿1例。行盲肠憩室切除合并阑尾切除术19例，回盲部切除术1例，右半结肠切除术1例，内科保守治疗成功13例。术后观察患者恢复情况及并发症发生率。结果 手术患者均痊愈出院，术后切口感染3例（14.3%），经换药后痊愈，无吻合口瘘及肠瘘发生，无围术期死亡。保守治疗13例患者出院后腹痛再发9例（69.2%），经抗感染治疗腹痛缓解出院。全部病例均定期随访，随访1～60个月，疗效持续，安全可行。结论 盲肠憩室炎误诊率高，常规术前CT可显著提高诊断正确率。其保守治疗成功率低，复发率高，积极建议手术治疗。可根据憩室炎症情况，有无穿孔，憩室数量等具体情况合理选择手术方式。

[关键词]盲肠憩室炎；急性阑尾炎；手术治疗

[中图分类号] R656.8 [文献标识码] A [文章编号] 1674-4721（2017）08（c）-0036-04

[Abstract]Objective To summarize the diagnosis and treatment experience of cecal diverticulitis.Methods Retrospective analysis of the clinical data of 34 cases of cecal diverticulitis admitted in the Taicang Hospital of Suzhou University from July 2011 to February 2017 was conducted.All patients showed acute right lower quadrant pain.23 cases of cecal diverticulitis diagnosed by abdominal CT before surgery，misdiagnosed as acute appendicitis in 10 cases，misdiagnosed as appendix abscess in 1 case.19 cases of appendectomy，1 case of ileocectomy，1 case of right colon resection，and 13 cases of conservative treatment of internal medicine.Postoperative observation of the recovery of patients and the incidence of complications.Results All patients were cured and discharged. Three cases （14.3%） were postoperative incision infection.After the dressing，the anastomotic fistula and intestinal fistula occurred.There was no perioperative death.Conservative treatment of 13 patients discharged from abdominal pain after discharge in 9 cases （69.2%），by anti-infective treatment of abdominal pain relief discharged.All cases were followed up regularly，followed up for 1-60 months，the effect of sustained， safe and feasible.Conclusion The rate of misdiagnosis of cecal diverticulitis is high，and conventional CT can significantly improve the accuracy of diagnosis.The conservative treatment of low success rate，high recurrence rate，the proposed active surgical treatment.According to the diverticular inflammation，with or without perforation，the number of diverticulum and other specific circumstances reasonable choice of surgical methods.

[Key words]Caecal diverticulitis；Acute appendicitis；Surgical treatment

盲腸憩室炎是一种少见的外科急腹症，多为后天肠石梗阻引起，该病临床表现与急性阑尾炎极其相似，加之盲肠位置与阑尾相近，且术中也难与克罗恩病、肿瘤等鉴别，往往通过术后病理得到证实，部分保守治疗患者需复查肠镜证实，误诊率高，其治疗方案也因人因时而异[1]，临床迫切需要提高对该疾病的认识及警惕性，提高确诊率，避免误诊、漏诊及发生憩室穿孔等严重并发症。……