The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned.Furthermore,emergency appendicectomy for appendiceal mass is increasingly performed ...The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned.Furthermore,emergency appendicectomy for appendiceal mass is increasingly performed with equal success and safety to that performed in non-mass forming acute appendicitis.There is an increasing volume of evidence-although mostly retrospective-that if traditional conservative management is adopted,there is no need for routine I.A except for a small number of patients who continue to develop recurrent symptoms.On the other hand,the routine adoption of emergency laparoscopic appendicectomy (LA) in patients presenting with appendiceal mass obviates the need for a second admission and an operation for I.A with a considerable complication rate.It also abolishes misdiagnoses and deals promptly with any unexpected ileo-cecal pathology.Moreover,it may prove to be more cost-effective than conservative treatment even without I.A due to a much shorter hospital stay and a shorter period of intravenous antibiotic administration.If emergency LA is to become the standard of care for appendiceal mass,I.A will certainly become 'something' of the past.展开更多
BACKGROUND Enhanced recovery after surgery(ERAS)protocol is a comprehensive manage-ment modality that promotes patient recovery,especially in the patients undergo-ing digestive tumor surgeries.However,it is less commo...BACKGROUND Enhanced recovery after surgery(ERAS)protocol is a comprehensive manage-ment modality that promotes patient recovery,especially in the patients undergo-ing digestive tumor surgeries.However,it is less commonly used in the appen-dectomy.AIM To study the application value of ERAS in laparoscopic surgery for acute appen-dicitis.METHODS A total of 120 patients who underwent laparoscopic appendectomy due to acute appendicitis were divided into experimental group and control group by random number table method,including 63 patients in the experimental group and 57 patients in the control group.Patients in the experimental group were managed with the ERAS protocol,and those in the control group were received the tra-ditional treatment.The exhaust time,the hospitalization duration,the hospita-lization expense and the pain score between the two groups were compared.RESULTS There was no significant difference in age,gender,body mass index and Sunshine Appendicitis Grading System score between the experimental group and the con-trol group(P>0.05).Compared to the control group,the patients in the expe-rimental group had earlier exhaust time,shorter hospitalization time,less hospi-talization cost and lower degree of pain sensation.The differences were statis-tically significant(P<0.01).CONCLUSION ERAS could significantly accelerate the recovery of patients who underwent la-paroscopic appendectomy for acute appendicitis,shorten the hospitalization time and reduce hospitalization costs.It is a safe and effective approach.展开更多
Low grade appendiceal mucinous neoplasm (LAMN) is a rare malignancy with incidence of 0.7% to 1.7% of all appendicectomies [1]. LAMN has the worst complication of mucin seeding into adjacent peritoneum leading to pseu...Low grade appendiceal mucinous neoplasm (LAMN) is a rare malignancy with incidence of 0.7% to 1.7% of all appendicectomies [1]. LAMN has the worst complication of mucin seeding into adjacent peritoneum leading to pseudomyxoma peritonei. LAMN lacks standardised treatment approach where only appendicectomy is preferred for resection of non metastatic disease. Case Presentation A 38 yr old female presented with right lower quadrant where CT Abdomen revealed Mucocele of Appendix. Patient underwent Laparoscopic Appendicectomy and Histopathological examination revealed Low grade appendiceal mucinous neoplasm. Patient is on regular follow up and is disease free. Conclusion low grade appendiceal mucinous neoplasm is usually an incidental finding where treatment depends on staging and histology of the tumour.展开更多
文摘The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned.Furthermore,emergency appendicectomy for appendiceal mass is increasingly performed with equal success and safety to that performed in non-mass forming acute appendicitis.There is an increasing volume of evidence-although mostly retrospective-that if traditional conservative management is adopted,there is no need for routine I.A except for a small number of patients who continue to develop recurrent symptoms.On the other hand,the routine adoption of emergency laparoscopic appendicectomy (LA) in patients presenting with appendiceal mass obviates the need for a second admission and an operation for I.A with a considerable complication rate.It also abolishes misdiagnoses and deals promptly with any unexpected ileo-cecal pathology.Moreover,it may prove to be more cost-effective than conservative treatment even without I.A due to a much shorter hospital stay and a shorter period of intravenous antibiotic administration.If emergency LA is to become the standard of care for appendiceal mass,I.A will certainly become 'something' of the past.
文摘目的评价超声引导下腹横肌平面阻滞(transverse abdominis plane block,TAPB)对儿童腹腔镜阑尾切除术后康复的影响。方法选取2019年2~11月首都医科大学附属北京儿童医院全麻喉罩下行腹腔镜阑尾切除手术的患儿36例,年龄6~17岁,美国麻醉医师协会(American Society of Anesthesiologist,ASA)分级Ⅰ或Ⅱ级,随机分为A、B两组,每组18例。A组采用肛塞小儿布洛芬栓;B组采用肛塞小儿布洛芬栓复合TAPB技术。分别记录术后1、3、6、12、24 h的静息疼痛评分和咳嗽疼痛评分,以及自主坐起活动和自主下地活动情况。同时记录两组术后躁动等相关不良反应及并发症的发生率。结果B组术后各时间点的静息VAS及咳嗽VAS均低于A组(P<0.05)。B组术后3 h自主坐起、术后6 h自主坐起和下地活动比例均显著高于A组(P<0.05)。结论超声引导下TAPB用于儿童腹腔镜阑尾切除术可提供术后早期良好的镇痛效果,促进术后早期自主活动,有利于术后康复。
基金The study was reviewed and approved by the Beijing Chao-Yang Hospital’s Ethics and Medical Committee(approval No.2018-Ke-340).
文摘BACKGROUND Enhanced recovery after surgery(ERAS)protocol is a comprehensive manage-ment modality that promotes patient recovery,especially in the patients undergo-ing digestive tumor surgeries.However,it is less commonly used in the appen-dectomy.AIM To study the application value of ERAS in laparoscopic surgery for acute appen-dicitis.METHODS A total of 120 patients who underwent laparoscopic appendectomy due to acute appendicitis were divided into experimental group and control group by random number table method,including 63 patients in the experimental group and 57 patients in the control group.Patients in the experimental group were managed with the ERAS protocol,and those in the control group were received the tra-ditional treatment.The exhaust time,the hospitalization duration,the hospita-lization expense and the pain score between the two groups were compared.RESULTS There was no significant difference in age,gender,body mass index and Sunshine Appendicitis Grading System score between the experimental group and the con-trol group(P>0.05).Compared to the control group,the patients in the expe-rimental group had earlier exhaust time,shorter hospitalization time,less hospi-talization cost and lower degree of pain sensation.The differences were statis-tically significant(P<0.01).CONCLUSION ERAS could significantly accelerate the recovery of patients who underwent la-paroscopic appendectomy for acute appendicitis,shorten the hospitalization time and reduce hospitalization costs.It is a safe and effective approach.
文摘Low grade appendiceal mucinous neoplasm (LAMN) is a rare malignancy with incidence of 0.7% to 1.7% of all appendicectomies [1]. LAMN has the worst complication of mucin seeding into adjacent peritoneum leading to pseudomyxoma peritonei. LAMN lacks standardised treatment approach where only appendicectomy is preferred for resection of non metastatic disease. Case Presentation A 38 yr old female presented with right lower quadrant where CT Abdomen revealed Mucocele of Appendix. Patient underwent Laparoscopic Appendicectomy and Histopathological examination revealed Low grade appendiceal mucinous neoplasm. Patient is on regular follow up and is disease free. Conclusion low grade appendiceal mucinous neoplasm is usually an incidental finding where treatment depends on staging and histology of the tumour.