◆Acute Simple Appendicitis. ◆Acute Suppurative or Gangrenous  appendicitis . ◆Acute Perforating Appendicitis. ◆Chronic Relapsing Appendicitis. ●B-US—Young woman.  ●Fluid therapy. ●Intravenous Antibiotics. ●Nasogastric suction.  ●Local or General anaesthesia.  Epidural Anaesthesia.●Lie Supine. ` ◆Activity in Early—Prevent Intestinal   Adhesion. ◆Normal Intestinal Activity—Oral Fluids. ◆Perforated Appendicitis—According to  Principals of Peritonitis.◆Drain the Peritorium Cavity. ※Hemorrhage.※Wound infection and dehiscence.※peritoneal cavity abscess.※Appendix-stump infection.※Adhesive ileus.※Intestinal fistula. * 阑尾切除术Appendectomy 主讲刘栋才副教授STRESSES AND DIFFICULTIES ●Local anatomy of appendix. ●Basic conception: McBurney point. ●Complications of acute appendicitis. 第一部分阑尾的外科解剖PartⅠ: Surgical anatomy of appendix  ◆General Conciderations. ◆Anatomic Position of Appendix. ◆McBurney point. ◆Mesoappendix. ●positions of the appendix   ●local anatomy of the appendix ●vessels of the appendix ●Essentials of Detecting Appendix:  ①the Taeniae of the Colon converge at the Base of the Appendix.  ②Approximately 2.5cm Below the ileocecal Valve. ACUTE APPENDICTTIS: Essentials of Diagnosis: ●Abdomial pains. ●Anorexia, nausea and vomiting. ●Localized abdominal tenderness. ●Low-grade fever. ●Leukocytosis. DIFFERENTIAL DIAGNOSIS: ●Mesenteric Lymphadentitis. ●Ureteral or Renal Calculi. ●Female Pelvic Disorders:  ＆A ruptured ovarian follicle.  ＆pelvic inflammatory disease.  ＆Twisted ovarian cyst.  ＆Ectopic pregnancy. ●Other Acute Surgical Emergencies. 第二部分阑尾切除术Appendectomy  Indications ◆Periappendiceal Abscess. ◆Benign Tumor of the Appendix. ◆Carcinid of the Appendix(<2cm) 。◆Appendicolithiasis. ●A history of more than 3 days’duration. ●A right iliac swelling which is almost certainly an  appendix abscess. Contra-indications Preoperative Management Anaesthesia and position of patient Normal appendix Inflamed appendix Choice of incision: ＊Position of Inflamed Appendix—Maximum Tenderness.  ＊Diagnosis. ＊Accompanied by Other Disease.  ＊Diffuse Peritonitis. ◆Common Incision: McBurney 麦氏切口脐Advantages: ＊no muscle-cutting,  tendency to close up  spontaneously. incisional hernial. ＊no injury to major vessels and nerves. ＊incision consistent with projection point of the  appendix. ＊extend to midline ,and beneficial to remove pelvic appendix. Disadvantages ：＊the worse approach to retrocaecal appendix.  ＊Disadvantageous to adequate exploration. ＊In the presence of peritonitis or dubious diagnosis.  A right Midline or paramedian incision to be performed. ＊Incision across the skin-lines—discontent with  cosmetic results. Other incisions: ＊Transverse Incision: the best approach to the inflamed appendix and the most satisfactory cosmetic. Especially to the retrocaecal appendix and fatty.  ＊Right Paramedian Incision:  adapt to the presence of peritonitis or dubious diagnosis, but wound infection can form easily incisional hernia. Incising the external oblique aponeurosis. 2.Incising the internal oblique insertion. Technic of appendectomy     3. Splitting internal oblique and transversus abdominis.  Technic of appendectomy 4. Incising the peritoneum Technic of appendectomy 5.the mesoappendix and vessels is divided. purse-string sture.     7.Ligation and invagination of appendix stump. Technic of appendectomy Operative Care ＊When the Diagnosis is in Doubt: Abdominal Cavity Exploration.  ①Peritoneal Cavity(gas, foods, bile etc.)—Stomach, Duodenum and Gollbladder.  ②Female (Bloody Fluid in Peritoneal Cavity) Ovarian and Salpingion. ③Appendix is normal—Examining the Last 100cm of the Ileum. Postoperative managements: Complications of the Acute Appendicitis ◆Perforation and Peritonitis:severe pain and high fever. About 50% of those under 10 or over age 50. Nearly all deaths occur in the latter group. ◆Appendiceal Abscess: Nonoperative management or drain the abscess. ◆Pylephlebitis: Chills,high fever, low-grade jaudice. ◆Hepatic Abscesses: Grave condition of pylephlebitis. OPERATIVE COMPLICATIONS ※Injuries: Inferior epigastric vessels.  Intestines.  Right ureter and iliac artery. ※Excision :  Right salpinx.  Fatty appendices.