超细子镜联合体表超声辅助内镜逆行阑尾炎治疗术在急性阑尾炎伴阑尾狭窄中的应用（含视频）

Application of ultra‑fine endoscopy combined with surface ultrasound‑assisted endoscopic retrograde appendicitis therapy for acute appendicitis with appendiceal stenosis (with video)

摘要:

目的 探讨超细子镜联合体表超声辅助内镜逆行阑尾炎治疗术（endoscopic retrograde appendicitis therapy，ERAT）在急性阑尾炎伴阑尾狭窄中的价值。方法 回顾性纳入2023年2月至2024年8月在吉林市人民医院就诊，经临床症状及影像学检查确诊的急性阑尾炎伴阑尾狭窄患者。患者均行超细子镜联合体表超声辅助ERAT治疗，超细子镜插入阑尾腔观察黏膜及狭窄情况，并在体表超声引导下通过冲洗、取石、支架引流等措施治疗阑尾炎。记录并分析患者基线资料、技术成功率、临床成功率、手术时间、术后住院时间、并发症及复发情况等指标。结果 共纳入47例患者，超细子镜联合体表超声辅助ERAT在47例患者中技术成功率为97.87%（46/47），临床成功率为95.74%（45/47），术后留置阑尾支架17例（36.17%），应用子母网篮取石8例（17.02%），术中及术后无并发症发生，手术时长（10.77±4.70）min，术后住院时间（3.26±1.59）d，随访（4.60±1.90）个月内有1例（2.13%）患者考虑复发。结论 超细子镜联合体表超声辅助ERAT治疗急性阑尾炎伴阑尾狭窄安全、有效、可行，保留了阑尾功能，减少了放射性暴露。

Abstract:

Objective To evaluate the ultra-fine endoscopy combined with surface ultrasound-assisted endoscopic retrograde appendicitis therapy (ERAT) for acute appendicitis with appendiceal stenosis. Methods Data of patients diagnosed as having acute appendicitis with appendiceal stenosis through clinical symptoms and imaging examination were retrospectively analyzed in Jilin People''s Hospital from February 2023 to August 2024. All patients underwent ERAT using an ultra-fine endoscope for intraluminal inspection of the mucosa and stenosis and surface ultrasound guidance for irrigation, stone extraction, and stent placement. The baseline data, technical success rate, clinical success rate, procedure time, postoperative hospital stay, complications and recurrence were recorded and analyzed. Results A total of 47 patients were included. Technical success was achieved in 97.87% (46/47) cases and clinical success in 95.74% (45/47). Appendiceal stenting was performed in 36.17% (17/47) and basket stone extraction in 17.02% (8/47). No intra- or postoperative complication occurred. The procedure time was 10.77±4.70 min, postoperative hospital stay was 3.26±1.59 d, and 1 patient (2.13%) relapsed during the follow-up period of 4.60±1.90 months. Conclusion The ultra-fine endoscopy, in combination with surface ultrasound-assisted ERAT, is safe, effective and feasible for the treatment of acute appendicitis with appendiceal stenosis, preserving the appendix function with less radiation.