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[摘要] 目的：探讨非典型急性阑尾炎的临床特点，及对其手术治疗适应证进行分析。方法：回顾性分析本院经手术治疗确诊的32例非典型急性阑尾炎患者的临床资料，汇总数据进行临床分析。结果：本组患者术后均证实为非典型急性阑尾炎，其中单纯性阑尾炎5例、化脓性阑尾炎20例、坏疽性急性阑尾炎7例。术后出现并发症共4例，其中切口感染2例，肠梗阻1例，肠瘘1例。所有患者均手术成功，治愈出院。结论：充分掌握非典型急性阑尾炎的临床表现，早诊断，早治疗，可改善预后。
[关键词] 非典型急性阑尾炎；手术；临床表现；分析
[中图分类号] R000 [文献标识码] A [文章编号] 1674-4721（2012）01（b）-177-02
Clinical analysis of 32 cases of patients with acute atypical appendicitis
ZHOU Mingyi
Department of Inpatient Surgery, People"s Hospital of Zhongkai District of Huizhou City in Guangdong Province, Huizhou 516229, China
[Abstract] Objective: To explore clinical performance in acute atypical appendicitis, and to analyze the corresponding operation indication. Methods: The clinical data of 32 cases of patients with surgical diagnosis of acute atypical appendicitis in our hospital were collected and analyzed retrospectively. Result: All the patients were proved to be acute atypical appendicitis after surgery. Among them, 20 cases were suppurated appendicitis, 7 cases were gangrened appendicitis, 5 cases were simple appendicitis. After surgery, 4 cases were suffered from complications, among them, 2 cases with incision infection, 1 case with ileus, 1 case with intestinal fistula. All the operation were successful, and patients were recovery and left hospital. Conclusion: Fully understanding of clinical performance in acute atypical appendicitis, early diagnose and treatment, help to improve prognosis.
[Key words] Acute atypical appendicitis; Surgery; Clinical performance; Analysis
急性阑尾炎是临床常见的急腹症，发病率高，且无年龄限制。典型临床症状为转移性右下腹疼痛，右下腹压痛、反跳痛，伴恶心、呕吐、发热，占发病总数的70%。而非典型急性阑尾炎的临床表现及体征均不典型，占发病总数的20%，常导致临床误诊或漏诊，严重威胁患者生命[1-2]。充分掌握非典型急性阑尾炎的临床表现及手术适应症对患者治疗及预后具有重要意义。本文对经手术治疗确诊的32例非典型急性阑尾炎患者的临床资料进行回顾性分析，探讨其临床表现，分析其手术适应证，以便临床采取合理的治疗方案，提高疗效，现报道如下：
1 资料与方法
1.1 一般资料
本院2007年5月～2011年5月收治32例非典型急性阑尾炎患者，男15例，女17例，年龄9～70岁，平均30.5岁，病程2 h～6 d，平均病程20.8 h。患者的临床症状体征：32例患者均无转移性右下腹痛，腹痛32例，上腹压痛7例，下腹压痛13例，仅右下腹压痛3例，全腹压痛、反跳痛9例，全腹膜炎7例，腹泻5例，恶心呕吐15例，胃寒发热10例，23例患者血常规显示白细胞升高，26例腹部B超异常。全部患者术后经病理证实，单纯性阑尾炎5例、化脓性阑尾炎20例、坏疽性急性阑尾炎7例。
1.2诊治
本组32例患者术前均不能作出急性阑尾炎明确诊断，术前诊断为腹痛原因待查21例，考虑为急性阑尾炎，术前考虑为其他急腹症14例，其中急性胆囊炎2例、急性上消化道穿孔6例、急性肠梗阻1例、卵巢囊肿蒂扭转4例、异位妊娠1例。入院后给予患者抗炎、降温等治疗，密切观察临床症状及体征。
10例患者行气管插管全身麻醉，22例患者行持续性硬膜外麻醉。19例采用经腹直肌探查切口手术，9例应用麦氏点切口手术，4例行压痛点一侧的腹直肌旁切口手术。所有患者开腹后，行上下腹腔常规检查，术中证实为非典型急性阑尾炎，行阑尾切除术，若患者阑尾周边有明显渗出物，加硅胶管腹腔引流，在术后2～3 d引流量
