Ding Wenjuan, Du Zhiqiang, Zhou Xiangrong
Department of Gastroenterology, Jianyang People's Hospital, 180 Yiyuan Road, Jianyang, Sichuan, 641400, China.
Surg Endosc. 2022 Apr;36(4):2480-2487. doi: 10.1007/s00464-021-08533-8. Epub 2021 May 13.
This study investigated the feasibility of endoscopic retrograde appendicitis therapy (ERAT) for the treatment of acute appendicitis.
There were 210 patients included who were admitted to our hospital from January 2017 to October 2019 with a diagnosis of acute appendicitis. According to the method of treatment, patients were stratified into the ERAT group, laparoscopic appendectomy (LA) group, or open appendectomy (OA) group for comparison of perioperative information extracted from the medical records of the patients.
The operations were successfully completed in all patients. The length of operation in the ERAT group (median: 48 min, range: 34-78 min) was significantly shorter compared to the LA group (median: 67 min, range: 47-90 min) or OA group (median: 85 min, range: 58-120 min). Postoperatively, the length of the hospital stay, the amount of time spent bedridden following surgery, surgery-related complications, and in-patient expenses were all significantly less than those in both the LA and OA groups (all p < 0.05). Moreover, the recurrence rate of appendicitis after ERAT was 2.86% during the first six months of postoperative follow-up. Thirteen patients in the ERAT group were diagnosed with appendicular abscesses, all of which successfully proceeded by colonoscopically incising the most protruding or fluctuating place around the appendix opening without procedure-related complications during the follow-up period.
ERAT is a safe and effective endoscopic treatment method for acute appendicitis and abscesses of the appendix. The advantages include reduced trauma, faster recovery times, and lower costs in comparison with either OA or LA procedures. ERAT with internal incision and drainage can be safely performed with immediate effect, especially in patients with acute uncomplicated appendicitis accompanied by either fecal stones or stenosis of the appendix cavity, or an abscess within the appendix cavity.
本研究探讨了内镜逆行性阑尾炎治疗术（ERAT）治疗急性阑尾炎的可行性。
纳入2017年1月至2019年10月在我院确诊为急性阑尾炎的210例患者。根据治疗方法，将患者分为ERAT组、腹腔镜阑尾切除术（LA）组或开腹阑尾切除术（OA）组，比较从患者病历中提取的围手术期信息。
所有患者手术均成功完成。ERAT组的手术时间（中位数：48分钟，范围：34 - 78分钟）明显短于LA组（中位数：67分钟，范围：47 - 90分钟）或OA组（中位数：85分钟，范围：58 - 120分钟）。术后，住院时间、术后卧床时间、手术相关并发症及住院费用均明显低于LA组和OA组（均p < 0.05）。此外，ERAT术后随访前6个月阑尾炎复发率为2.86%。ERAT组有13例患者被诊断为阑尾脓肿，所有患者均通过结肠镜在阑尾开口周围最突出或波动处切开，随访期间无手术相关并发症。
ERAT是一种治疗急性阑尾炎和阑尾脓肿的安全有效的内镜治疗方法。与OA或LA手术相比，其优点包括创伤小、恢复快、成本低。ERAT联合内镜下切开引流可安全有效地进行，尤其适用于伴有粪石或阑尾腔狭窄或阑尾腔内脓肿的急性单纯性阑尾炎患者。
