内镜逆行阑尾炎治疗术治疗急性非复杂性阑尾炎的临床价值

doi:10.3969/j.issn.1004-583X.2025.10.006

摘要/Abstract

摘要：

目的本研究聚焦内镜逆行阑尾炎治疗术(endoscopic retrograde appendicitis therapy, ERAT)在急性非复杂性阑尾炎(acute uncomplicated appendicitis, AUA)治疗中的临床效果。方法选取2022年1月-2024年1月于河北医科大学第三医院住院的AUA患者为研究对象,通过电话随访形式进行知情同意,并依据治疗方式分为内镜逆行阑尾炎治疗术(endoscopic retrograde appendicitis therapy, ERAT)组(n=26)、腹腔镜阑尾切除术(laparoscopic appendectomy, LA)组(n=63)、非手术治疗(non-operative management, NOM)组(n=37)。对比3组炎症因子水平、住院时间及费用、并发症发生率及复发率等。结果 3组初始治愈率、不良事件发生率差异无统计学意义,均能有效缓解疼痛。WBC值及NEUT值均下降(P<0.05),在治疗后1 d,LA组IL-6、PCT及CRP值高于ERAT组和NOM组(P<0.05),不同治疗方式的D-二聚体差异无统计学意义。与LA组相比,ERAT组首次下床时间更短(P<0.01)。与NOM组相比,ERAT组首次体温下降时间、住院时间更短(P<0.05)。LA组住院费用最高,ERAT组次之,NOM组最低(P<0.05)。NOM组复发率最高,其次为ERAT组,LA组最低,其中肥胖、保留阑尾及存在阑尾粪石是AUA复发的独立危险因素(P<0.05)。结论 ERAT作为一种微创治疗手段,在AUA的治疗中展现出显著的临床价值,与LA、NOM相比具有独特优势。

关键词: 阑尾炎, 内镜逆行阑尾炎治疗术, 腹腔镜阑尾切除术, 非手术治疗

Abstract:

Objective To explore the clinical efficacy of endoscopic retrograde appendicitis therapy (ERAT) of acute uncomplicated appendicitis (AUA). Methods AUA patients hospitalized in the Hebei Medical University Third Hospital from January 2022 to January 2024 were selected for the study. Informed consent was obtained via telephone follow-up. Patients were divided into three groups according to their treatment modality: ERAT group (n=26), laparoscopic appendectomy (LA) group (n=63), and non-operative management (NOM) group (n=37). Inflammatory marker levels, length of hospitalization and costs, incidence of complications, and recurrence rates were compared among the three groups. Results The initial cure rate and incidence of adverse events were comparable across all three treatment methods, and all surgical methods could effectively alleviate pain. Both the white blood cell count (WBC) and neutrophil count (NEUT) decreased significantly (P<0.05). On day 1 post-treatment, interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) in the LA group were significantly higher than the ERAT and NOM groups (P<0.05), while D-dimer was comparable. Patients in the ERAT group had significantly shorter duration of off-bed activities than the LA group (P<0.01). Compared with NOM group, patients in the ERAT group had significantly shorter duration of first temperature drop and length of stay (P<0.05). Cost of hospitalization was the highest in LA group, followed by ERAT and NOM groups (P<0.05). The highest recurrent rate was seen in the NOM group, followed by ERAT and LA groups. Obesity, preservation of the appendix and presence of appendiceal fecal stones were independent risk factors for the recurrence of AUA (P<0.05). Conclusion ERAT, as a minimally invasive treatment option, demonstrates significant clinical value in the management of AUA, offering unique advantages over LA and NOM.

Key words: appendicitis, endoscopic retrograde appendicitis therapy, laparoscopic appendectomy, non-operative management

中图分类号:

R574.61

张怡晗, 刘恬玉, 焦黎, 孟霞, 郝雨绒, 梁玉龙, 王军民. 内镜逆行阑尾炎治疗术治疗急性非复杂性阑尾炎的临床价值[J]. 临床荟萃, 2025, 40(10): 910-917.

Zhang Yihan, Liu Tianyu, Jiao Li, Meng Xia, Hao Yurong, Liang Yulong, Wang Junmin. Clinical study of endoscopic retrograde appendicitis therapy of acute uncomplicated appendicitis[J]. Clinical Focus, 2025, 40(10): 910-917.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2025.10.006

https://www.lchc.cn/CN/Y2025/V40/I10/910

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参考文献 26

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组别	例数	初始治疗成功率[例(%)]	复发率 [例(%)]	发热 [例(%)]	首次体温下降时间 (h)	住院时间 (d)	治疗期间不良事件 [例(%)]
ERAT组	26	25(96.2)	3(11.5)	20(76.9)	8.25(7.25, 10.50)	4.50(4.00, 6.00)	1(3.8)
LA组	63	63(100)	1(1.6)^*	58(92.1)	10.00(7.75, 16.25)	5.00(4.00, 7.00)	5(7.9)
NOM组	37	34(91.9)	11(29.7)^#	32(86.4)	14.00(10.00, 22.75)^*	7.00(5.00, 8.00)^*#	3(8.1)
F/Z/χ²值		4.919	17.607	9.000	12.721	11.921	0.476
P值		0.054	<0.01	0.342	0.002	0.003	0.816

组别	例数	初始治疗成功率[例(%)]	复发率 [例(%)]	发热 [例(%)]	首次体温下降时间 (h)	住院时间 (d)	治疗期间不良事件 [例(%)]
ERAT组	26	25(96.2)	3(11.5)	20(76.9)	8.25(7.25, 10.50)	4.50(4.00, 6.00)	1(3.8)
LA组	63	63(100)	1(1.6)^*	58(92.1)	10.00(7.75, 16.25)	5.00(4.00, 7.00)	5(7.9)
NOM组	37	34(91.9)	11(29.7)^#	32(86.4)	14.00(10.00, 22.75)^*	7.00(5.00, 8.00)^*#	3(8.1)
F/Z/χ²值		4.919	17.607	9.000	12.721	11.921	0.476
P值		0.054	<0.01	0.342	0.002	0.003	0.816

组别	例数	手术耗时(min)	首次下床时间(h)
ERAT组	26	48.50(38.75, 63.75)	4.00(3.75, 6.00)
LA组	63	634.00(3.75, 6.00)	11.00(8.00, 16.00)
Z值		1.144	6.709
P值		0.252	<0.01

组别	例数	手术耗时(min)	首次下床时间(h)
ERAT组	26	48.50(38.75, 63.75)	4.00(3.75, 6.00)
LA组	63	634.00(3.75, 6.00)	11.00(8.00, 16.00)
Z值		1.144	6.709
P值		0.252	<0.01

组别	例数	治疗前	治疗后1 d	Z值	P值
ERAT组	26	5.00(3.75, 6.00)	2.00(1.00, 2.25)	-4.406	<0.01
LA组	63	5.00(3.00, 7.00)	2.00(1.00, 3.00)	-6.984	<0.01
NOM组	37	4.00(3.00, 5.00)	2.00(1.00, 2.00)	-5.421	<0.01
χ²值		2.670	5.527
P值		0.263	0.063