右下腹部痛(Right Lower Quadrant Pain)シリーズ18 EXPERT COURSE 解答 【症例 RE 89】

急性虫垂炎.Acute appendicitis.







右側結腸(A:上行結腸,C:盲腸)は図12までで,回腸末端(TI)は図7から始まる.図12の1と図13の2の糞石が虫垂根部で,図13と図14でUターンし,図12の5から拡張し始め図3の14で盲端になる.図6の11では最大径1cm以上に腫大し(目盛りは図9の右縁),図2と図3で虫垂先端周囲の脂肪組織の濃度上昇も認め,急性虫垂炎である.手術および病理所見(図A):phlegmonous appendicitis.








文献考察1):腹腔鏡下虫垂切除は穿孔例に有用
Yonsei Med J. 2004 Feb 29;45(1):7-16.
Is laparoscopic appendectomy useful for the treatment of acute appendicitis in Korea? A meta-analysis.
Kim CB, Kim MS, Hong JH, Lee HY, Yu SH.
We performed a meta-analysis using results in the Korean literatures to determine whether laparoscopic appendectomy (LA) or open appendectomy (OA) provide the better outcome in possible acute appendicitis patients. To perform the meta-analysis, an extensive literature search was conducted, giving priority to the Journal of the Korean Surgical Society, and domestic literature in its search database, published since January 1993, to ascertain the usefulness of LA in the treatment of acute appendicitis. The criteria used for the quality evaluation were as follows: 1) study subjects must have been evaluated clinically for suspected acute appendicitis, and 2) articles were included only if sufficient data (e.g. patient number, mean and standard deviation of patient outcome variables) were available regarding patient outcomes for LA or OA treated appendicitis. Of the 136 articles retrieved, 8 studies (1,258 patients) were selected for quantitative meta-analysis. Because insufficient data was available in some studies, operating time and hospitalization days were assessed for all 8 studies, but the time required to return to full functioning was assessed for only 3 studies. Overall effect size estimates were calculated using a random effect model for four patient outcomes (operating time, Q=38.6699, p
文献考察2):腹腔鏡下と開腹虫垂切除,唯一の差は腹腔鏡下のほうが日常生活への復帰が早い
Br J Surg. 2005 Mar;92(3):298-304.
Randomized clinical trial of laparoscopic versus open appendicectomy for confirmed appendicitis.
Moberg AC, Berndsen F, Palmquist I, Petersson U, Resch T, Montgomery A.
BACKGROUND: Laparoscopy is safe for diagnostic and therapeutic purposes in patients with suspected acute appendicitis. This study compared recovery after laparoscopic (LA) and open appendicectomy (OA) for confirmed appendicitis, carried out by experienced surgeons in an educational setting. METHODS: One hundred and sixty-three patients with laparoscopically confirmed appendicitis suitable for LA were randomized prospectively to either LA or OA in a blinded fashion. The primary endpoint was time to full recovery. Secondary endpoints were operating time, complications, hospital stay and functional status. RESULTS: There was no significant difference between LA and OA in time to full recovery (9 and 11 days respectively; P = 0.225). Operating time was 55 min in the LA group and 60 min in the OA group (P = 0.416). The complication rate was 8.6 and 11.0 per cent respectively (P = 0.696), and median hospital stay was 2 days in both groups (P = 0.192). Functional status was significantly better in the LA group 7-10 days after operation (P = 0.045). CONCLUSION: There was no difference in time to full recovery after LA and OA in patients with laparoscopically confirmed appendicitis. A trend towards better physical activity was noted after the laparoscopic procedure.PMID: 15609378

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