Li Yingchao, Mi Chen, Li Weizhi, She Junjun
Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, China.
Department of General Surgery, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, China.
Dig Dis Sci. 2016 Nov;61(11):3285-3291. doi: 10.1007/s10620-016-4245-8. Epub 2016 Jul 13.
Acute appendicitis is the most common abdominal emergency, but the diagnosis of appendicitis remains a challenge. Endoscopic retrograde appendicitis therapy (ERAT) is a new and minimally invasive procedure for the diagnosis and treatment of acute appendicitis.
To investigate the diagnostic value of ERAT for acute appendicitis by the combination of colonoscopy and endoscopic retrograde appendicography (ERA).
Twenty-one patients with the diagnosis of suspected uncomplicated acute appendicitis who underwent ERAT between November 2014 and January 2015 were included in this study. The main outcomes, imaging findings of acute appendicitis including colonoscopic direct-vision imaging and fluoroscopic ERA imaging, were retrospectively reviewed. Secondary outcomes included mean operative time, mean hospital stay, rate of complication, rate of appendectomy during follow-up period, and other clinical data.
The diagnosis of acute appendicitis was established in 20 patients by positive ERA (5 patients) or colonoscopy (1 patient) alone or both (14 patients). The main colonoscopic imaging findings included mucosal inflammation (15/20, 75 %), appendicoliths (14/20, 70 %), and maturation (5/20, 25 %). The key points of ERA for diagnosing acute appendicitis included radiographic changes of appendix (17/20, 85 %), intraluminal appendicoliths (14/20, 70 %), and perforation (1/20, 5 %). Mean operative time of ERAT was 49.7 min, and mean hospital stay was 3.3 days. No patient converted to emergency appendectomy. Perforation occurred in one patient after appendicoliths removal was not severe and did not require invasive procedures. During at least 1-year follow-up period, only one patient underwent laparoscopic appendectomy.
ERAT is a valuable procedure of choice providing a precise yield of diagnostic information for patients with suspected acute appendicitis by combination of colonoscopy and ERA.
急性阑尾炎是最常见的腹部急症，但阑尾炎的诊断仍然是一项挑战。内镜逆行阑尾炎治疗术（ERAT）是一种用于诊断和治疗急性阑尾炎的新型微创手术。
通过结肠镜检查和内镜逆行阑尾造影术（ERA）相结合的方法，探讨ERAT对急性阑尾炎的诊断价值。
本研究纳入了2014年11月至2015年1月期间接受ERAT治疗的21例疑似单纯性急性阑尾炎患者。回顾性分析急性阑尾炎的主要结局及影像学表现，包括结肠镜直视成像和透视下ERA成像。次要结局包括平均手术时间,平均住院时间、并发症发生率、随访期间阑尾切除术的发生率以及其他临床数据。
20例患者通过单独的阳性ERA（5例）或结肠镜检查（1例）或两者（14例）确诊为急性阑尾炎。主要的结肠镜影像学表现包括黏膜炎症（15/20，75%）、阑尾结石（14/20，70%）和阑尾开口成熟（5/20，25%）。ERA诊断急性阑尾炎的关键点包括阑尾的影像学改变（17/20，85%）、腔内阑尾结石（14/20，70%）和穿孔（1/20，5%）。ERAT的平均手术时间为49.7分钟，平均住院时间为3.3天。没有患者转为急诊阑尾切除术。1例患者在阑尾结石取出后发生穿孔，但不严重，无需进行侵入性手术。在至少1年的随访期内，只有1例患者接受了腹腔镜阑尾切除术。
ERAT是一种有价值的选择方法，通过结肠镜检查和ERA相结合，为疑似急性阑尾炎患者提供准确的诊断信息。
