Genier F, Plattner V, Letessier E, Armstrong O, Heloury Y, Le Neel J C
Clinique Chirurgicale, Hôpital de la Mère et de l'Enfant, CHRU Nantes.
J Chir (Paris). 1995 Oct;132(10):393-8.
Appendicitis, usually a benign disease, can have its prognosis worsened in case of postoperative fistula. The latter occurs rarely after open appendectomy (0.133%), but accounts for 10% of the morbidity rate. The authors reviewed 22 cases of these fistulas, treated during a 24-year period (January 1970 to December 1993). The aim of these retrospective study was to precise their clinical features, to evaluate paraclinical examinations in diagnosing these complications and to give guidelines for their treatment. Fistulas occurred at day 14 in the postoperative course. In 21 case, appendicitis was severe (suppurative, gangrenous or perforated) or appendectomy quoted as technically difficult. Location of the appendix was atypical in 7 cases. Drainage of the site was performed in 17 cases at the time of appendectomy. Diagnosis was made on the aspect of the drainage fluid in 14 cases. Diagnosis workup of the fistula associated plain abdominal radiograph and abdominal ultrasonography (n = 22). Fistulography (n = 6) confirmed the clinical diagnosis of fistula, showing the leaking in all cases. Medical treatment was attempted first in 14 cases and was successful in 11 cases with a healing time from 13 to 72 days. Surgical treatment (open drainage of the site) was attempted first in 11 cases, and was mandatory in 3 other cases because of medical treatment failure: one patient died and 5 patients underwent re-operation (right colectomy in 3 cases, bypass in 1 case and re-drainage in 1 case). Fistulography in our experience, is highly reliable and is considered to be a great assistance in management of these fistulas. Medical treatment remains the best initial treatment modality. Surgery must be contemplated in case of established external fistulas, and of purulent or faecal fistulas. Nevertheless, prognosis remains poor (50% re-operation rate).
阑尾炎通常是一种良性疾病，但术后发生瘘管时其预后会恶化。后者在开放性阑尾切除术后很少发生（0.133%），但占发病率的10%。作者回顾了在24年期间（1970年1月至1993年12月）治疗的22例此类瘘管病例。这项回顾性研究的目的是明确其临床特征，评估辅助检查在诊断这些并发症中的作用，并给出治疗指南。瘘管在术后第14天出现。21例中阑尾炎病情严重（化脓性、坏疽性或穿孔性）或阑尾切除术被认为技术难度较大。7例阑尾位置不典型。17例在阑尾切除时对手术部位进行了引流。14例根据引流液情况做出诊断。对瘘管进行的诊断检查包括腹部平片和腹部超声检查（n = 22）。瘘管造影（n = 6）证实了瘘管的临床诊断，所有病例均显示有渗漏。14例首先尝试保守治疗，11例成功，愈合时间为13至72天。11例首先尝试手术治疗（手术部位开放引流），另外3例因保守治疗失败而必须进行手术：1例患者死亡，5例患者接受了再次手术（3例行右半结肠切除术，1例行旁路手术，1例行再次引流）。根据我们的经验，瘘管造影非常可靠，被认为对这些瘘管的处理有很大帮助。保守治疗仍然是最佳的初始治疗方式。对于已形成的外瘘、脓性或粪性瘘管，必须考虑手术治疗。然而，预后仍然很差（再次手术率为50%）。
