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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
Objective To investigate the clinical features and diagnosis and treatment of acute appendicitis in patients with liver transplantation. Methods A total of 817 adult cadaver liver transplantation were performed in our department during the past 7 years. Four cases were complicated with acute appendicitis in the early postoperative period. The author retrospectively analyzed the clinical data of 4 patients and 4 patients misdiagnosed as appendicitis. Results The incidence of early acute appendicitis after liver transplantation was 0.49% (4/817). The 4 patients developed symptoms of acute appendicitis at 8th, 13th, 11th, and 9th day after liver transplantation, including paroxysmal right lower quadrant paroxysmal pain, fever, right lower quadrant tenderness, rebound pain and leukocytosis. In 2 cases, On the same day, two patients underwent emergency appendectomy on the second day after the onset of symptoms. No appendix perforation who. Postoperative pathology prompted two cases of simple appendicitis, two cases of suppurative appendicitis. Appendicitis in the pathogenesis and treatment, not adjusted immunosuppressive agents, liver function without adverse effects. All the 4 cases recovered well after operation. So far, 84, 62, 40 and 29 months after liver transplantation. The other 4 cases were misdiagnosed as acute appendicitis. One patient was perforation of duodenal diverticulum at 9 days after operation. One patient was perforation of jejunum on day 10 after operation (15 days after operation). Two patients were postoperative 8 days and Gallbladder occurred on day 11, and the latter died 4 months after surgery. Conclusions The prevalence of appendicitis after liver transplantation is low, so it is necessary to identify the complications such as biliary fistula and digestive tract perforation. For patients with confirmed appendicitis,