盲肠憩室炎34例诊治体会

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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。

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	范峰
	康涛
	陆耀良

关键词 ：盲肠憩室炎, 急性阑尾炎, 手术治疗

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

收稿日期: 2017-06-12

PACS:

R656.8

引用本文:

范峰, 康涛, 陆耀良. 盲肠憩室炎34例诊治体会[J]. 中国当代医药, 2017, 24(24): 36-39.
FAN Feng, KANG Tao, LU Yao-liang. Experience of the treatment for 34 patients of caecal diverticulitis. 中国当代医药, 2017, 24(24): 36-39.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2017/V24/I24/36

[1]	吴孟超,吴在德.黄家驷外科学[M].7版.北京：人民卫生出版社,2008：1535-1537.
[2]	张遂,刘勇,刘震,等.盲肠憩室炎的临床诊治分析[J].华西医学,2009,24（6）：1375-1377.
[3]	喻志革.盲肠憩室炎25例诊治分析[J].中外医疗,2013,32（28）：78-79.
[5]	Keidar S,Pappo I,Shperber Y, et al .Cecal diverticulitis：a diagnostic challenge[J].Dig Surg,2000,17（5）：508-512.
[7]	李智勇,赵海燕,伍建林.结肠憩室炎的CT研究进展[J].大连医科大学学报,2008,30（5）：480-482.
[8]	苪晓辉.急性右侧结肠憩室炎的超声检查[J].国际外科学杂志,2002,（3）：188-189.
[4]	Rotert H,Noldge G,Encke J, et al .The value of CT for the diagnosis of acute diverticulitis[J].Radiologe,2003,43（1）：51-58.
[6]	Fang JF,Chen RJ,Lin BC, et al .Aggressive resection is indicated for cecal diverticulitis[J].Am J Surg,2003,185（2）：135-140.
[9]	徐飞,章萍,徐牡丹,等.右侧结肠憩室炎的超声误诊分析[J].医学影像学杂志,2010,20（6）：797.
[10]	Oudenhoven LF,Koumans RK,Puylaert JB.Right colonic diverticulitis：US and CT findings-new insights about frequency and natural history[J].Radiology,1998,208（3）：611-618.
[11]	Strate LL,Peery AF,Neumann I.American Gastroenterological Association Institute Technical Review on the Management of Acute Diverticulitis[J].Gastroenterology,2015,149（7）：1950-1976.e12.
[12]	Stollman N,Smalley W,Hirano I.American Gastroenterological Association Institute Guideline for the Management of Acute Diverticulitis[J].Gastroenterology,2015,149（7）：1944-1949.
[13]	赵威.中国人结肠憩室发病特点研究[D].上海：第二军医大学,2007.
[14]	Harada RN,Jr WT.Surgical management of cecal diverticulitis[J].Am J Surg,1993,166（6）：666-669.
[15]	Papaziogas B,Makris J,Koutelidakis I, et al .Surgical management of cecal diverticulitis：is diverticulectomy enough?[J].Int J Colorectal Dis,2005,20（1）：24-27.