一次性子母胆道镜辅助内镜逆行阑尾炎治疗术对急性非复杂性阑尾炎的诊断和治疗价值分析

Analysis of the diagnostic and therapeutic value of single-use mother-baby choledochoscope-assisted endoscopic retrograde appendicitis therapy for the acute uncomplicated appendicitis

摘要:

目的 探讨一次性子母胆道镜辅助内镜逆行阑尾炎治疗术在急性非复杂性阑尾炎治疗中的诊断和治疗价值。方法 回顾性分析2022年9月－2024年9月该院内镜中心通过一次性子母胆道镜辅助内镜逆行阑尾炎治疗术治疗的39例急性非复杂性阑尾炎患者的临床资料，观察内镜下表现、子母网篮取石率、阑尾支架置入率、技术成功率、临床成功率、手术时间、住院时间、并发症发生率和术后6 h视觉模拟评分法（VAS）评分，以及术后24 h炎症指标。结果 28例（71.8%）患者结肠镜下阑尾开口可见充血和水肿，10例（25.6%）患者结肠镜下阑尾开口可见脓液流出，32例（82.1%）患者子镜下阑尾腔内可见大量脓液，20例（51.3%）患者子镜下阑尾腔内可见粪石；一次性子母胆道镜辅助内镜逆行阑尾炎治疗术的技术成功率为100.0%（39/39）；手术时间（21.08±7.49）min；住院时间（3.97±2.08）d；8例（20.5%）患者行内镜下子母网篮取石术；14例（35.9%）患者行阑尾支架置入术。临床成功率为97.4%（38/39），1例患者术后临床症状和炎症指标未缓解，转外科行阑尾切除术。38例患者术后6 h的VAS评分 < 3分，腹痛症状明显缓解；术后24 h白细胞计数和中性粒细胞百分比较术前明显下降，差异均有统计学意义（P < 0.05）；39例患者均未发生并发症；术后随访（5.94±4.03）个月，3例（7.7%）出现复发。结论 一次性子母胆道镜辅助内镜逆行阑尾炎治疗术诊断和治疗急性非复杂性阑尾炎，安全且有效，值得临床推广应用。

Abstract:

Objective To investigate the diagnostic and therapeutic value of single-use mother-baby choledochoscope-assisted endoscopic retrograde appendicitis therapy in the treatment of acute uncomplicated appendicitis.Methods A retrospective analysis was conducted on the clinical data of 39 patients with acute uncomplicated appendicitis who underwent single-use mother-baby choledochoscope-assisted endoscopic retrograde appendicitis treatment at the Endoscopy center of the hospital from September 2022 to September 2024. Observe the endoscopic manifestations, the rate of maternal and child basket stone removal, the rate of appendiceal stent implantation, the technical success rate, the clinical success rate, the operation time, the hospital stay, the incidence of complications, the visual analogue scale (VAS) score 6 hours after the operation, and the inflammatory indicators 24 hours after the operation.Results In 28 cases (71.8%), congestion and edema could be seen at the opening of the appendix under colonoscopy. In 10 cases (25.6%), pus could be seen flowing out of the opening of the appendix under colonoscopy. In 32 cases (82.1%), a large amount of pus could be seen in the lumen of the appendix under subscopy. In 20 cases (51.3%), appendiceal fecalith could be seen in the lumen of the appendix under subscopy. The technical success rate of single-use mother-baby choledochoscope-assisted endoscopic retrograde appendicitis treatment was 100.0% (39/39). The operation time was (21.08 ± 7.49) min; Hospital stay: (3.97 ± 2.08) days; Eight cases (20.5%) of patients underwent endoscopic maternal basket stone removal. Appendiceal stent implantation was performed in 14 cases (35.9%) of patients. The clinical success rate is 97.4% (38/39). One patient's clinical symptoms and inflammatory indicators did not improve after the operation, and was transferred to the surgery department for appendectomy. The VAS score of 38 patients was less than 3 points 6 hours after the operation, and the abdominal pain symptoms were significantly relieved. The white blood cell count and the percentage of neutrophils 24 hours after the operation decreased significantly compared with those before the operation, and the differences were statistically significant (P < 0.05). None of the 39 patients had complications. The postoperative follow-up was (5.94 ± 4.03) months, and recurrence occurred in 3 cases (7.7%).Conclusion single-use mother-baby choledocoscope-assisted endoscopic retrograde appendicitis therapy is safe and effective in the diagnosis and treatment of acute uncomplicated appendicitis, which is worthy of further promotion and popularization in clinical practice.