University Surgical Unit, Teaching Hospital Ragama, Ragama, Sri Lanka.
Surg Endosc. 2010 Nov;24(11):2793-5. doi: 10.1007/s00464-010-1049-3. Epub 2010 Apr 8.
Management of chronic right iliac fossa (CRIF) pain is poorly documented in literature. No guidelines are available on the best therapeutic approach.
Patients presenting from October 2007 to August 2009 with pain persisting or recurring in right lower abdomen over a period of 6 weeks or more were assessed. Severity of CRIF pain was documented using a ten-point visual analogue scale. Initial history and examination were followed by urine analysis, blood counts, X-ray and ultrasound scan of the abdomen. Full colonoscopy was performed in all negative cases. Diagnostic or therapeutic laparoscopy was offered to patients with normal initial investigations. The normal-looking appendix was removed in the absence of other positive laparoscopic findings. Patient's immediate complications, pain score at 8 weeks and histology of appendix were assessed.
Nineteen patients with median age of 43 years (range 32-52 years) underwent laparoscopy. All were female. Median pain score was 5 (range 4-6). During surgery, 12 (64%) had positive findings. Of these, 6 (30%) had adhesions, which were separated. Three patients with congested appendices were removed. One caecal perforation, tubal mass and ovarian cyst were treated laparoscopically. Seven (36%) patients who had macroscopically normal appendices underwent appendicectomy. There were no immediate postoperative complications. Significant improvement was seen in overall pain score after surgery (median 5, range 4-6 versus median 0, range 0-6; p = 0.001). However, only 57% of patients with normal appendix had improved pain scores (median 5, range 4-6 versus median 1, range 0-6; p = 0.12). All patients with positive laparoscopic findings improved after surgery.
Laparoscopy seems effective in evaluation and treatment of CRIF pain. The role of appendicectomy with normal-looking appendix needs further evaluation.
慢性右髂窝（CRIF）疼痛的管理在文献中记录不佳。目前尚无关于最佳治疗方法的指南。
评估 2007 年 10 月至 2009 年 8 月期间出现持续或反复发作右下腹痛 6 周或以上的患者。使用 10 分视觉模拟评分法记录 CRIF 疼痛的严重程度。对初始病史和检查进行尿分析、血常规、腹部 X 线和超声检查。所有阴性病例均行全结肠镜检查。对初始检查正常的患者提供诊断或治疗性腹腔镜检查。在没有其他阳性腹腔镜发现的情况下，切除外观正常的阑尾。评估患者的即时并发症、8 周时的疼痛评分和阑尾的组织学。
19 例患者的中位年龄为 43 岁（范围 32-52 岁），均为女性。中位疼痛评分为 5 分（范围 4-6 分）。手术中，12 例（64%）有阳性发现。其中，6 例（30%）有粘连，予以分离。3 例充血性阑尾切除。1 例盲肠穿孔、输卵管肿块和卵巢囊肿行腹腔镜治疗。7 例（36%）阑尾外观正常的患者行阑尾切除术。术后无即时并发症。手术后总体疼痛评分显著改善（中位数 5 分，范围 4-6 分与中位数 0 分，范围 0-6 分；p=0.001）。然而，只有 57%的阑尾外观正常的患者疼痛评分得到改善（中位数 5 分，范围 4-6 分与中位数 1 分，范围 0-6 分；p=0.12）。所有腹腔镜阳性发现的患者手术后均有改善。
腹腔镜检查似乎对 CRIF 疼痛的评估和治疗有效。阑尾切除术在外观正常的阑尾中的作用需要进一步评估。
