陈德艺+韦良宏+陈海东+韦良鹏+沈丽丽

【摘要】目的比较急性单纯性阑尾炎内镜下阑尾腔冲洗联合抗生素治疗与单纯抗生素治疗的临床效果。方法将78例符合纳入标准的急性单纯性阑尾炎患者按志愿原则分为内镜下阑尾腔冲洗联合抗生素治疗39例（观察组），单纯抗生素治疗39例（对照组），比较两种治疗方法的腹痛改善情况、抗生素使用时间、住院时间、并发症发生率、治愈率、复发率等指标。结果两组患者都能达到临床治愈，治愈率为100%。观察组患者第1、3、5 天腹痛逐渐减轻直至消失，与对照组比较差异有统计学意义（P<0.001），观察组疗效优于对照组。观察组的腹痛消失时间、抗生素使用时间、住院时间均少于对照组，两组比较差异有统计学意义（P<0.05或0.01）。两组均无并发症。观察组复发1例，复发率为2.56%，对照组复发5例，复发率为12.82%，两组复发率比较差异无统计学意义（P>0.05）。结论与单纯抗生素治疗相比，内镜下阑尾腔冲洗联合抗生素治疗具有炎症消退时间短、病情恢复快、住院时间短等优点，是急性单纯性阑尾炎患者首选的治疗方式。

【关键词】急性单纯性阑尾炎；内镜下阑尾腔冲洗；抗生素

中图分类号：R574.61文献标识码：ADOI：10.3969/j.issn.1003-1383.2017.06.005

【Abstract】ObjectiveTo compare the clinical effects of endoscopic appendectomy combined with antibiotic and simple antibiotic in the treatment of acute simple appendicitis.Methods78 patients with acute simple appendicitis who met the inclusion criteria were divided into endoscopic appendectomy combined with antibiotic group（observation group）and simple antibiotic group（control group）with 39 cases in each group according to the principle of volunteering.Then，the improvement of abdominal pain，antibiotic use time，length of hospital stay，complication rate，cure rate and recurrence rate，etc.were compared between the two methods of treatment.ResultsBoth groups were able to achieve clinical cure，with a cure rate of 100%.The abdominal pain in the observation group gradually decreased and then disappeared at the first，third and fifth day of treatment，compared with the control group，difference was statistically significant（P<0.001）.The observation group had better effect than the control group.The disappearance time of abdominal pain，antibiotic use time，length of hospital stay of the observation group were all shorter than those of the control group，difference was statistically significant（P<0.05 or 0.01）.No complications were found in the two groups.Recurrence was found in 1 case in the observation group，recurrence rate was 2.56%，and 5 cases in the control group，recurrence rate was 12.82%，difference was not statistically significant（P>0.05）.ConclusionCompared with simple antibiotic，endoscopic appendectomy combined with antibiotic has the advantages of short duration of inflammation，rapid recovery and short hospitalization time，etc.It is the first choice for the treatment of acute simple appendicitis.

【Key words】acute simple appendicitis；endoscopic appendectomy；antibiotics

急性闌尾炎是目前临床最常见的急腹症，多年以来，阑尾切除术一直是治疗急性阑尾炎的最主要方法，由于外科手术治疗存在一定的手术风险、切口感染、术后并发肠粘连、腹部伤口瘢痕形成等缺点，部分患者不愿选择手术治疗，或由于合并其他疾病不宜手术治疗；而单纯抗生素治疗又存在治疗失败需中转手术或复发率高等问题。2012年有专家提出了内镜逆行阑尾炎治疗术（endoscopic retrograde appendicitis therapy，ERAT）用于治疗急性非穿孔性阑尾炎患者[1～2]，在国内外多家医院实践中显示优越性[3～5]，但其复发率仍然是每个临床……