Garlipp B, Arlt G
Abteilung für Allgemein, Viszeral- und Unfallchirurgie, Park-Klinik Weissensee, Berlin, Germany.
Chirurg. 2009 Jul;80(7):615-21. doi: 10.1007/s00104-009-1761-5.
The question whether an appendix found to be macroscopically normal at laparoscopy for suspected appendicitis should be removed remains open to debate. Potential advantages of appendicectomy in all cases include early diagnosis of neoplastic lesions that cannot be detected macroscopically, diagnosis and cure of neurogenic appendicectomy, avoidance of diagnostic confusion in later episodes of abdominal pain, and prevention of appendicitis developing later in life. Therefore, adopting a strategy of always removing the appendix even if it is found to be uninflamed at laparoscopy seems justified as long as it does not imply an increase in postoperative morbidity. We retrospectively studied all patients undergoing laparoscopic appendicectomy in which a "normal appendix" was found and all patients undergoing diagnostic laparoscopy in our hospital during a 7-year period. Our data as well as a critical review of the literature show that removal of the appendix does not increase morbidity compared to simple diagnostic laparoscopy and should always be done when performing laparoscopy for suspected acute appendicitis.
对于在腹腔镜检查中发现外观正常但疑似阑尾炎的阑尾是否应予以切除,这一问题仍存在争议。在所有病例中进行阑尾切除术的潜在益处包括早期诊断肉眼无法检测到的肿瘤性病变、诊断和治愈神经源性阑尾炎、避免在以后的腹痛发作中出现诊断混淆,以及预防日后发生阑尾炎。因此,只要不意味着术后发病率增加,采取即使在腹腔镜检查中发现阑尾未发炎也总是将其切除的策略似乎是合理的。我们回顾性研究了我院7年间所有接受腹腔镜阑尾切除术且术中发现“正常阑尾”的患者,以及所有接受诊断性腹腔镜检查的患者。我们的数据以及对文献的批判性综述表明,与单纯诊断性腹腔镜检查相比,切除阑尾不会增加发病率,并且在对疑似急性阑尾炎进行腹腔镜检查时应始终进行阑尾切除。