成人肝移植术后早期并发急性阑尾炎的诊断和治疗分析
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何晓顺 E-mail:gdtrc@163.com

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R 617

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Diagnosis and treatment of acute appendicitis after orthotopic liver transplantation in adult
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    摘要:

    目的:探讨肝移植患者术后早期并发急性阑尾炎的临床特点及诊疗经验。
    方法:7年间笔者单位共实施817例成人尸肝移植,4例术后早期并发急性阑尾炎。笔者回顾性分析该4例患者以及误诊为阑尾炎的另4例患者的临床资料。
    结果:肝移植术后早期急性阑尾炎的发生率为0.49%(4/817)。该4例患者分别于肝移植术后8,13,11,9 d出现急性阑尾炎症状,包括右下腹阵发性疼痛,发热,右下腹压痛、反跳痛,白细胞升高;2例于出现症状当天,2例于症状出现后第2天急诊行阑尾切除术。无阑尾穿孔者。术后病理提示2例为单纯性阑尾炎,2例为化脓性阑尾炎。阑尾炎发病及治疗过程中,未调整免疫抑制剂,肝功能无不良影响。4例术后均顺利恢复,迄今肝移植术后分别存活84,62,40,29个月。其余4例误诊为急性阑尾炎的患者1例为术后9 d十二指肠憩室并穿孔,1例为术后10 d空肠穿孔(术后15 d死亡);2例分别为术后8 d及11 d发生胆瘘,后者术后4个月死亡。
    结论:肝移植术后阑尾炎的患病率低,需与胆瘘、消化道穿孔等并发症鉴别;对于确诊患者应尽早行阑尾切除术。

    Abstract:

    Objective:To investigate the clinical characteristics, diagnosis and treatment of acute appendicitis after orthotopic liver transplantation (OLT) in adult. 
    Methods:The clinical data of 4 liver transplant recipients with acute appendicitis after transplantation and 4 patients with misdiagnosed appendicitis from Jan 2000  to Dec 2007 were studied retrospectively.
    Results:The incidence rate of acute appendicitis after OLT was 0.49%(4/817)in our single center. The 4 patients complained of right lower quadrant abdominal pain and fever on the 8th, 13th, 11th and 9th day post-transplantion, respectively. Tenderness in right lower abdomen and rebound tenderness were presented, and white blood cells counts was elevated. Appendicetomy was perfomed in 2 cases on the 1st day and in 2 cases on the 2nd day of the onset of symptoms. No appendicular perforation was found during the operation. The patients recovered and well during followed up for 84m, 62m, 40m and 29m, respectively. The other 4 misdiagnosed patients were diagnosed with duodenal diverticulum perforation in 1 case, jejunum perforation in 1 case and bile leakage in 2 cases after exploratory laparotomy.
    Conclusions:The incidence rate of acute appendictis after OLT is low, and should be differentiaed from other surgical complications, such as gastrointestinal perforation and bile leakage. Appendicetomy should be performed as early as possible in patients with definite diagnosis.

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巫林伟|何晓顺|王东平|鞠卫强|邰强|朱晓峰|马毅|王国栋|胡安斌.成人肝移植术后早期并发急性阑尾炎的诊断和治疗分析[J].中国普通外科杂志,2010,19(7):726-729.

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  • 收稿日期:2009-11-26
  • 最后修改日期:2010-05-16
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  • 在线发布日期: 2010-07-15
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