胆道子镜辅助内镜逆行阑尾炎治疗术治疗急慢性阑尾炎27例临床分析

doi:10.3969/j.issn.1004-583X.2026.07.003

摘要/Abstract

摘要：

目的探讨胆道子镜辅助内镜逆行阑尾炎治疗术(endoscopic retrograde appendicitis therapy,ERAT)在急慢性阑尾炎微创治疗中的临床疗效及应用价值。方法回顾性分析 2024年4月-2025年12月于福建中医药大学附属福鼎医院消化内科接受胆道子镜辅助ERAT治疗的27例急慢性阑尾炎患者的临床资料,记录结肠镜及胆道子镜下表现、手术相关指标、术后恢复情况,并对患者进行术后随访,统计病情复发率与疗效满意率。结果 27例中急性阑尾炎7例、慢性阑尾炎20例,胆道子镜插管成功率达100%,其中直接插管18例(66.7%)、导丝辅助插管9例(33.3%),手术时间为19(14, 28) min,术中无出血、穿孔等并发症发生。结肠镜下可见阑尾开口充血肿胀16例(59.3%)、脓性分泌物流出5例(18.5%),阑尾开口呈黏膜下隆起样改变4例(14.8%),粪石嵌顿1例(3.7%),胆道子镜下观察阑尾腔内黏膜充血肿胀23例(85.2%)、可见粪石/粪渣16例(59.3%)、可见脓液/絮状物11例(40.7%)。术后6 h所有患者疼痛视觉模拟评分均<3分,症状及体征缓解率100%,平均住院时间为(5.11±1.83) d;术后中位随访12个月,患者病情复发率为0,疗效满意率100%,4例留置阑尾支架者支架均于术后1个月自行脱落,1例黏膜活检患者病理提示为增生性息肉,另有3例术前腹部CT检查阴性的患者经该技术明确诊断并完成有效治疗。结论胆道子镜辅助ERAT治疗非穿孔性、非坏疽性急慢性阑尾炎安全有效,具有插管成功率高、术后恢复快、复发率低的优势,并可提供鉴别诊断价值,为临床上阑尾炎治疗方案提供参考依据。

关键词: 阑尾炎, 胆道子镜, 内镜逆行阑尾炎治疗术(ERAT), 疗效, 价值

Abstract:

Objective To investigate the clinical efficacy and application value of biliary endoscopy-assisted endoscopic retrograde appendicitis therapy (ERAT) in the minimally invasive treatment of acute and chronic appendicitis. Methods A retrospective analysis was performed on the clinical data of 27 patients with acute or chronic appendicitis who underwent biliary endoscopy-assisted ERAT in the Department of Gastroenterology, the Affiliated Fuding Hospital of Fujian University of Traditional Chinese Medicine from April 2024 to December 2025. Colonoscopic and biliary endoscopic findings, procedure-related indicators, and postoperative recovery were recorded. Patients were followed up after surgery, and the recurrence rate and treatment satisfaction rate were calculated. Results Among the 27 patients, 7 had acute appendicitis and 20 had chronic appendicitis. The biliary endoscope insertion success rate was 100%, including 18 cases of direct insertion (66.7%) and 9 cases of guidewire-assisted insertion (33.3%). The procedure time was 19 (14, 28) min, and no complications such as bleeding or perforation occurred during the operation. Colonoscopy showed hyperemia and edema of the appendiceal orifice in 16 cases (59.3%), purulent discharge in 5 cases (18.5%), submucosal protrusion-like changes at the appendiceal orifice in 4 cases (14.8%), and fecalith impaction in 1 case (3.7%). Under biliary endoscopy, hyperemia and edema of the appendiceal mucosa were observed in 23 cases (85.2%), fecaliths/fecal debris in 16 cases (59.3%), and pus/flocculent material in 11 cases (40.7%). At 6 h after surgery, all patients had a visual analogue scale score <3, with a 100% symptom and sign relief rate. The mean hospital stay was (5.11±1.83) d. After a median follow-up of 12 months, the recurrence rate was 0 and the treatment satisfaction rate was 100%. In the 4 patients with appendiceal stents placed, all stents spontaneously detached 1 month after surgery. Pathology of 1 patient who underwent mucosal biopsy suggested hyperplastic polyp. In addition, 3 patients with negative preoperative abdominal CT findings were definitively diagnosed and successfully treated with this technique. Conclusion Biliary endoscopy-assisted ERAT is safe and effective for nonperforated, nongangrenous acute and chronic appendicitis. It offers a high insertion success rate, rapid postoperative recovery, and a low recurrence rate, while also providing diagnostic value for differential diagnosis. It may serve as a reference for clinical decision-making in appendicitis treatment.

Key words: appendicitis, biliary endoscopy, endoscopic retrograde appendicitis therapy (ERAT), efficacy, value

中图分类号:

R574.61

夏宁宁, 吴以龙, 杨沱, 林钦棋, 林卫星, 林敏. 胆道子镜辅助内镜逆行阑尾炎治疗术治疗急慢性阑尾炎27例临床分析[J]. 临床荟萃, 2026, 41(7): 596-601.

Xia Ningning, Wu Yilong, Yang Tuo, Lin Qinqi, Lin Weixing, Lin Min. Clinical analysis of 27 cases of acute and chronic appendicitis treated with biliary endoscopy-assisted endoscopic retrograde appendicitis therapy[J]. Clinical Focus, 2026, 41(7): 596-601.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.07.003

https://www.lchc.cn/CN/Y2026/V41/I7/596

图/表 3

图1 结肠镜下阑尾表现 a.阑尾窝黏膜正常;b.阑尾窝黏膜隆起、充血肿胀;c.阑尾窝呈黏膜下隆起样改变;d.阑尾窝可见粪石嵌顿

Fig.1 Appendiceal findings under colonoscopy a. Normal mucosa of the appendiceal orifice; b. Elevated, hyperemic, and edematous mucosa at the appendiceal orifice; c. Submucosal protrusion-like change at the appendiceal orifice; d. Fecalith impaction visible at the appendiceal orifice

图2 胆道子镜下阑尾内腔表现 a.阑尾内壁黏膜充血、肿胀;b.阑尾腔内可见脓性分泌物/絮状物;c.阑尾腔内可见长条形粪石;d.阑尾腔内可见黏膜息肉样隆起

Fig.2 Appendiceal lumen findings under biliary endoscopy a. Hyperemia and edema of the appendiceal mucosa; b. Purulent secretions/flocculent material visible in the appendiceal lumen; c. Long strip-shaped fecalith visible in the appendiceal lumen; d. Polypoid mucosal protrusion visible in the appendiceal lumen

图3 内镜下治疗 a.胆道子镜通过结肠镜活检钳道直接插入阑尾腔;b.胆道子镜通过导丝辅助插入阑尾腔;c.沿开口处置入导丝及乳头切开刀,生理盐水加压冲洗后可见大量脓液流出;d.用洞察网篮取出阑尾腔内粪石;e.对阑尾腔内黏膜进行活检;f.阑尾腔内置入塑料支架

Fig.3 Endoscopic treatment a. Biliary endoscope inserted directly into the appendiceal lumen through the colonoscopic biopsy channel; b. Biliary endoscope inserted into the appendiceal lumen with guidewire assistance; c. A guidewire and a papillotome were introduced along the appendiceal orifice, and after pressurized irrigation with normal saline, a large amount of pus was seen flowing out; d. Fecaliths were removed from the appendiceal lumen using a Dormia basket; e. Biopsy of the appendiceal mucosa; f. Placement of a plastic stent into the appendiceal lumen

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