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題名 | Diverticulitis of the Right Colon: Five Years Experience=右側結腸之急性憩室炎 |
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作者 | 謝忠和; 陳顯榮; 王正儀; Hsieh, Chung-ho; Chen, Shean-rong; Wang, Jeng-yi; |
期刊 | 中華民國外科醫學會雜誌 |
出版日期 | 20000700、20000800 |
卷期 | 33:4 民89.07-08 |
頁次 | 頁166-170 |
分類號 | 416.245 |
語文 | eng |
關鍵詞 | 右側結腸; 急性憩室炎; Diverticulitis; Right colon; Surgery; |
中文摘要 | 右側結腸之急性憩室炎在西方人為一種罕見的情形,在東方人則較為常見。在診斷上,有其相當的困難性;在處置上,也有許多的爭議。本篇報告收集從1995年至1999年26例右側結腸急性憩室炎之病例,針對病人特質與臨床表現、檢驗與檢查、及處置與預後作描述性分析;並探討合適的處置方式。 由我們的經驗顯示,右側結腸之急性憩室炎發生率明顯高於國外統計。若術前即診斷為右側結腸之急性憩室炎,以保守的抗生素治療優先考量。採用較為保守的闌尾切除術與引流合併術後抗生素治療,足以治癒大部分的病例。對於基底較為狹窄、類似息肉之憩室,則可採取憩室切除術。若合併膜瘍等併發症、或術中無法分辨是否惡性時,則可採取右側結腸切除術。 |
英文摘要 | We describe twenty-six cases of right-sided diverticulitis at our hospital during a 5- year period and discuss the most appropriate strategy for this condition. There were 14 men and 12 women with ages ranging from 17 to 86 years (mean 41.2). A preoperative diagnosis of appendicitis was made in 23(88%) of these patients. Four patients(15 %) presented with fever, 18(69 %) had symptoms for longer than 24hrs, and 21(81 %) had an elevated white blood cell count. Twentyfour of the patients underwent surgery, without bowel preparation. During surgery, cecal diverticulitis was found in 13 patients and ascending colon diverticulitis was found in 11 patients. One patient received a segmental resection, three patients had a diverticulectomy with appendectomy, and twenty patients received an appendectomy with drainage and postoperative antibiotic therapy. The mean hospital stay was 9.5 days(ranged from 7 to 29). There were 2 postoperative wound infections and no operative mortality. The mean follow up period was 1.7 years(ranged from 2months to 4.5 years). There were no recurrences during this period. Our experience shows that conservative antibiotic treatment was first considered if the diagnosis was made preoperatively. Appendectomy with drainage and postoperative antibiotic therapy may be suitable for most uncomplicated cases diagnosed during surgery. Diverticulectomy is feasible for polypoid diverticula with a narrow base. Right hemicolectomy is performed when malignancy is considered, or if there is perforation or abscess formation. |
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