老年人急性阑尾炎诊治的探讨.docVIP

老年人急性阑尾炎诊治的探讨 　　【摘要】 目的 探讨老年人急性阑尾炎临床特点、诊断要点和早期合理的治疗方法。方法 对58例手术治疗的老年人急性阑尾炎临床表现、诊断方法、手术时机及效果进行回顾性分析。结果 入院后24 h内诊断手术50例,超过24 h 8例。术前明确诊断46例,其中B超提示诊断6例,CT提示诊断5例;诊断不明剖腹探查手术12例。单纯阑尾切除38例,阑尾切除及腹腔置管引流14例,单纯切开引流6例。治愈56例(96.55%),死亡2例。结论 老年人急性阑尾炎临床表现多不典型,其诊断复杂而困难,尽早明确诊断、并根据不同患者特点选择个体化手术方案、在最佳时机进行手术治疗,同时积极治疗伴发病,能显著改善此类患者疗效。 　　【关键词】 　　急性阑尾炎;老年人;诊断和治疗 　　 　　Diagnosis and treatment of elderly patients with acute appendicitis 　　MENG Ling-qi.Heze peony people,s hospital,Shandong Heze,274015,China 　　 　　【Abstract】 Objective To explore the clinical characteristics,diagnostic essential and early effective therapeutic Strategy.Methods The manifestations,diagnostic methods,surgical timing and effects of 58 cases elderly patients with acute appendicitis were analyzed retrospectively.Results 50 cases were diagnosed and received operation within 24 h after admission,the other 8 cases were over 24 h.Preoperative diagnosis were clear in 46 cases,of which B type ultrasonic prompt diagnosis of 6 cases,CT prompt diagnosis of 5 cases;another 12 cases werediagnosed with laparotomy.Simple appendectomy in 38 cases,appendectomy and peritoneal catheter drainage in 14 cases,simple incision and drainage in 6 cases.56 patients(96.55%)were Cured,but 2 died.Conclusion Clinical manifestations of acute appendicitis in the elderly is not typical,the diagnosis of many of its are complex and difficult.Early diagnosis,timely and correct surgical treatment can significantly improve the therapeutic efficacy in such patients. 　　【Key words】 　　Acute appendicitis; Elderly people; Diagnosis and treatment 　　 　　菏泽市牡丹人民医院2005年1月至2008年12月手术治疗60岁以上急性阑尾炎患者58例,报告如下。 　　1 临床资料 　　1.1 一般资料 本组男38例,女20例;年龄60~70岁35例,71~80岁18例,80岁以上5例。发病至就诊时间:24 h以内8例(13.79%),24~48 h15例(25.86%),超过48 h35例(60.34%)。 　　1.2 临床表现 患者均有不同程度的下腹痛或腹胀,但典型的转移性右下腹痛史只有21例(36.2%)。麦氏点附近有固定压痛点30例(51.72%);典型右下腹压痛、反跳痛20例(34.48%),但腹肌紧张不明显。血常规白细胞计数超过10×10?9/L 15例(25.86%),中性粒细胞在80%以上25例(43.1%)。白细胞数不高者达43例(74.14%)多。体温高于37.5℃ 18例(31.03%)。术前出现休克或休克早期表现者12例(20.6