臨牀消化器内科 Vol.14 No.11(2-2)


特集名 虫垂疾患とその周辺
題名 虫垂疾患の各論 (2)特殊な虫垂炎の診断と治療 b.小児の虫垂炎
発刊年月 1999年 10月
著者 里見 昭 埼玉医科大学小児外科
【 要旨 】 虫垂炎は小児の急性腹症のなかでもっとも一般的な疾患である.小児は概して診療に非協力的で,ほかの愁訴を腹痛と表現したり腹痛自体の訴えが不明確であること,さらにその臨床像がきわめて複雑なことからしばしば診断に戸惑うことが多い.しかも早期診断のための技術と知識は昔と大差がなく,多くの場合,診断の根拠は触診所見である.しかし超音波検査,CT検査をはじめとする画像診断機器の進歩は,虫垂炎の診断のみならず病理組織学的病型の診断をも可能にしつつある.筆者らはカラードプラおよび虫垂壁の波形分析からこれらを区別する診断基準を設定,臨床に応用している.また腹腔鏡の普及は虫垂炎の治療法にも影響を与えている.筆者らは虫垂を膳部創より引き出し,直視下に切除術(虫垂先端が創外に出ないときは逆行性に)を行うOne Port Methodを考案,良好な結果を得ている.
Theme Disease of Appendix and its Allied Condition
Title Acute Appendicitis in Children
Author Akira Satomi Pediatric Surgery, Saitama Medical School
[ Summary ] Acute appendicitis is a common disease in children. In general, children express refusal to have their abdomens palpated and it is difficult to diagnose becausethey express other complaints such as indefinate abdominal pain. New techniques and knowledge related to early diagnosis are little different from the old methods, therefore, the grounds for diagnosis are based on the findings from palpation in most cases. However, improvements in ultrasonography (US) and computed tomography technologies are enabling us to diagnose not only acute appendicitis but also to establish histopathological classifications. We have created a diagnostic criterion for distinct histopathological classification using color Doppler US and analysis of wave motion on the wall of the appendix. Catarrhalis appendicitis which should not be operated on is distinguishable from other types of appendicitis. In other cases the popularization of laparoscopic surgery has influenced the treatment of acute appendicitis. We have operated using the one port method, in which the appendix is pulled out through the extra abdominal cavity in the umbilical region, at which time the appendectomy is performed.
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