急性阑尾炎(讲稿)

急性阑尾炎AcuteAppendicitisOutlinesIncidenceAnatomy&PhysiologyEtiology&PathogenesisEssentialsofDiagnosisComplicationsDifferentialDiagnosisTreatment2IncidenceThemostcommonacutesurgicalconditionofabdomen.

(Occursin6%oftheUSpopulation.)Mostfrequentlyin10~30years.Sexratio=1:1.

(In15-25yearsM:F=2:1)3Anatomy&PhysiologyAnatomyPositionoftheappendix:

constantontheleftanddorsallytothececum,2.5cmbelowtheileocecalvalve.Freeend-pelvic,retrocecal,retroileal,L/Rlowerquadrant.Landmark:

Threetaeniaecoliconvergeatthebaseoftheappendix.

5体表定位6AnatomyPositionVariation7AnatomyVascularsupply:

Appendixartery-

branchofileo-colicartery.89PhysiologyLymphoidtissue.Apartofthegut-associatedlymphoidtissues(GALT).10Etiology&PathogenesisEtiologyObstruction:

fecaliths,foreignbody(barium,vegetableandfruitseeds,intestinalworms-ascarids),truecalculi,gallstone,cecumCa,primarytumor,adhesionorhypertrophyoflymphoidtissue.Bacteriology:

anaerobes,aerobes,orfacultativebacteria.12Etiology&PathogenesisClosedloopobstructionBacterialinfection

mucosasecretionDistension&dilationCapillariesoccludedvenulesoccludedGangrene&perforationPeritonitis(LocalizedorGeneralized)13临床病理分型1.急性单纯性阑尾炎2.急性化脓性阑尾炎3.坏疽性及穿孔性阑尾炎4.阑尾周围脓肿14EssentialsofDiagnosis

ClinicalManifestations.Laboratory&ImagingFindings.15ClinicalManifestationsSymptoms:

1.Abdominalpain.

2.Anorexia,nauseaandvomiting.Signs:3.Localizedabdominaltenderness.

4.Muscularresistanceandreflexrigidity.

5.Low-gradefever.16Laboratory&ImagingFindings1.Leukocytosis.10,000~18,000/mm32.Plainfilm:localizedair-fluidlevers.3.Chestfilm,bariumenema&CT.4.Ultrasound:Specificdiagnostictechnique.5.Laparoscopy:

distinguishgynecologicdiseaseandileitisfromappendicitis.17AcuteAppendicitisRefineYourResults(pubmed›-20091207All8415Review(582)

FreefullText(905)

US,CT,MRdiagnosisPathobacteriaandAntibioticsLapvs.OpenappendectomySuspectedandseverepatients(neonatal/old/pregnancy/SLE/TB/DM/Complicationstreatment181920右下腹解剖（B超）21探头腹壁腰大肌阑尾22阑尾的B超表现2324ComplicatedappendicitisPerforation,Peritonitis.Abscess.Fistula.Pylephlebitis.25DifferentialDiagnosis1.Acutemesentericadenitis(淋巴结炎).2.Acutegastroenteritis.3.Femalepelvicdisorders:

(Rupturedovarianfollicle,Pelvicinflammatorydisease,Twistedovariancyst,Estopicpregnancy.)4.GenitourinaryDiseases:

(Ureteralorrenalcalculi,pyelonephritis.)5.Otheracuteemergencies:

(perforatedulcer,acutecholecystitis,pancreatitis,diverticulitis,intestinalabstruction,Meckle’sdiverticlitis,perforatedcarcinoma)6.Systemicdiseases.26内科外科妇科急性胃肠炎消化道溃疡穿孔异位妊娠破裂急性肠系膜淋巴结炎肠梗阻卵巢囊肿扭转Meckel憩室炎急性胆囊炎卵巢滤泡或黄体破裂局限性回肠炎急性胰腺炎急性盆腔炎心胸疾病输尿管结石急性附件炎其他泌尿系感染其他其他鉴别诊断27常见急腹症问诊查体辅助检查消化道穿孔溃疡病史、发病突然腹肌紧张强直立位腹平片肠梗阻排气排便情况立位腹平片急性胰腺炎胆囊结石病史左上腹压痛血AMY泌尿系结石腰痛、会阴放射痛肾区叩痛尿常规，泌尿系超声妇科疾病月经史尿HCG，妇科超声必要时请相关科室会诊！鉴别诊断28鉴别诊断胃穿孔合并不全肠梗阻29鉴别诊断卵巢囊肿孕12周合并右侧卵巢黄体囊肿破裂30阑尾类癌31TreatmentOperation-Appendectomy:1.Acuteappendicitis.2.Rupturedappendixwithlocalperitonitisorphlegmon(蜂窝织炎)formation.3.RupturedappendixwithspreadingperitonitisAntibiotics.Intervetionaltherapy:AbscessSupportivetreatment:BowelFistula323334特殊类型阑尾炎Infantandchildren.PregnancyTheElderly35急性单纯性阑尾炎（B超）36急性单纯性阑尾炎37急性化脓性阑尾炎（B超）38急性化脓性阑尾炎39坏疽穿孔性阑尾炎40坏疽性阑尾炎41亚急性阑尾炎42慢性阑尾炎43THREATMENTLAPAROSCOPICSURGERYSIGNODSTOMY44Oneofthemostcommonconditionsinchildrenandadults.Patientsusuallypresentwithperiumbilicalpainthatlaterlocalizestotherightlowerquadrant(RLQ)atMcBurney'spoint.Inmostcases,painisaccompaniedbymildanorexiaandnauseaorvomiting.Inmostsituations,signsandsymptomscanestablishthediagnosisreliably.Thecombinationofabdominalpainandtendernessaccompaniedbyleukocytosis>12,000cells/mm3hadthehighestpredictivevalueforacuteappendicitisAppendicitis454.Insomepatientsthereisadelayindiagnosisresultinginincreasedriskofperforation,sepsis,andevendeath.Inarecentseriesofchildhoodappendicitis,all10patients<10yrshadaperforatedappendixatthetimeofoperation.In35childrenbetween1-5yrswithappendicitisperforationrateof69%.19.8%morbidityrateamongptswithperforatedappendicitis.Thesurgicalliterature:25%ofpatientsundergoingthenegativeappendectomyrate.

46Thegoalwouldbethreefold:Todiagnoseappendicitispromptly