appendectomy

虫垂切除術

　 　

WordNet

1. surgical removal of the vermiform appendix (同)appendicectomy

PrepTutorEJDIC

1. 虫垂切除[手術]

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/06/17 13:37:19」(JST)

wiki en

[Wiki en表示]

Appendectomy
Intervention
An appendectomy in progress
ICD-10-PCS	0DTJ?ZZ
ICD-9-CM	47.0
MeSH	D001062

An appendectomy (sometimes called appendisectomy or appendicectomy) is the surgical removal of the vermiform appendix. This procedure is normally performed as an emergency procedure, when the patient is suffering from acute appendicitis. In the absence of surgical facilities, intravenous antibiotics are used to delay or avoid the onset of sepsis; it is now recognized that many cases will resolve when treated perioperatively. In some cases the appendicitis resolves completely; more often, an inflammatory mass forms around the appendix, causing transruptural flotation. This is a relative contraindication to surgery.

Appendectomy may be performed laparoscopically (this is called minimally invasive surgery) or as an open operation. Laparoscopy is often used if the diagnosis is in doubt, or if it is desirable to hide the scars in the umbilicus or in the pubic hair line. Recovery may be a little quicker with laparoscopic surgery; the procedure is more expensive and resource-intensive than open surgery and generally takes a little longer, with the (low in most patients) additional risks associated with pneumoperitoneum (inflating the abdomen with gas). Advanced pelvic sepsis occasionally requires a lower midline laparotomy.

History

The first recorded successful appendectomy was in 1735 when French surgeon Claudius Aymand described the presence of a perforated appendix within the hernial sac of an 11-year-old boy who had undergone successful appendicectomy. The operation was performed on December 6, 1735, at St. George’s Hospital in London. The organ was perforated by a pin the boy had apparently swallowed. The patient, Hanvil Andersen, made a spectacular recovery and was discharged a month later.

There have been some cases of auto-appendectomies, i.e. operating on yourself. One was performed by Evan O'Neill Kane in 1921, but the operation was completed by his assistants. Another case is Leonid Rogozov who had to perform the operation on himself as he was the only surgeon on a remote Antarctic base.

Procedure

In general terms, the procedure for an open appendectomy is as follows.

Surgeons perform a laparoscopic appendectomy.

1. Antibiotics are given immediately if there are signs of sepsis, otherwise a single dose of prophylactic intravenous antibiotics is given immediately prior to surgery.
2. General anaesthesia is induced, with endotracheal intubation and full muscle relaxation, and the patient is positioned supine.
3. The abdomen is prepared and draped and is examined under anesthesia.
4. If a mass is present, the incision is made over the mass; otherwise, the incision is made over McBurney's point, one third of the way from the anterior superior iliac spine (ASIS) and the umbilicus; this represents the position of the base of the appendix (the position of the tip is variable).
5. The various layers of the abdominal wall are then opened.
6. The effort is always to preserve the integrity of abdominal wall. Therefore, the External Oblique Aponeurosis is slitted along its fiber, and the internal oblique muscle is split along its length, not cut. As the two run at right angles to each other, this prevents later Incisional hernia.
7. On entering the peritoneum, the appendix is identified, mobilized and then ligated and divided at its base.
8. Some surgeons choose to bury the stump of the appendix by inverting it so it points into the caecum.
9. Each layer of the abdominal wall is then closed in turn.
10. The skin may be closed with staples or stitches.
11. The wound is dressed.
12. The patient will be brought to the recovery room.

Pregnancy

If appendicitis develops in a pregnant woman, an appendectomy is usually performed and should not harm the fetus. The risk of fetal death in the perioperative period after an appendectomy for early acute appendicitis is 3% to 5%. The risk of fetal death is 20% in perforated appendicitis.

Recovery

Scar and bruise 2 days after operation.

Scar 10 days after operation. Male, 23-y.o. patient. Hospital "Manuel Gea González", Mexico City, Tuesday, March 8, 2011.

Recovery time from the operation varies from person to person. Some will take up to three weeks before being completely active; for others it can be a matter of days. In the case of a laparoscopic operation, the patient will have three stapled scars of about an inch in length, between the navel and pubic hair line. When a laparotomy has been performed the patient will have a 2–3 inch scar, which will initially be heavily bruised.

Cost

United States

While appendectomy is a standard surgical procedure, its cost has been found to vary considerably in the United States. A 2012 study from the University of California, San Francisco published in the Archives of Internal Medicine analyzed 2009 data from nearly 20,000 adult patients treated for appendicitis in California hospitals. Researchers examined “only uncomplicated episodes of acute appendicitis” that involved “visits for patients 18 to 59 years old with hospitalization that lasted fewer than four days with routine discharges to home.” The lowest charge for removal of an appendix was $1,529 and the highest $182,955, more than 120 times greater. The median charge was $33,611. While the study was limited to California, the researchers indicated that the results were applicable anywhere in the United States. Many, but not all, patients, are covered by some sort of medical insurance.

References

External links

• Laparoscopic Appendectomy Video (includes case presentation)
• Open appendectomy, appendectomy Part of the operative howto series, explaining the steps in carrying out an open appendectomy
• Open & Laparoscopic appendectomy, appendectomy Open and Laparoscopic appendectomy
• A video of the procedure
• Another video of the procedure (Either Requires Windows Media Player and will not load in Firefox 1.5; or use this direct link with any player that can play .wmv files.)

UpToDate Contents

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• 1. 成人における急性虫垂炎のマネージメント management of acute appendicitis in adults
• 2. 小児における急性虫垂炎：管理 acute appendicitis in children management
• 3. 腹腔鏡下手術に用いる腹部アクセス法 abdominal access techniques used in laparoscopic surgery
• 4. 成人における消化管手術後の創部感染の予防策 control measures to prevent surgical site infection following gastrointestinal procedures in adults
• 5. 成人における急性虫垂炎：診断のための評価 acute appendicitis in adults diagnostic evaluation

English Journal

• Risk of Acute Appendicitis in and Around Pregnancy: A Population-based Cohort Study From England.

• Zingone F1, Sultan AA, Humes DJ, West J.
• Annals of surgery.Ann Surg.2015 Feb;261(2):332-7. doi: 10.1097/SLA.0000000000000780.
• OBJECTIVE: To determine the absolute and relative risk of acute appendicitis during the antepartum and postpartum periods compared with the time outside pregnancy among women of childbearing age.BACKGROUND: Acute appendicitis is the most common nonobstetric surgical emergency during pregnancy. Estim
• PMID 24950289

• Suprapubic single incision laparoscopic appendectomy.

• Wang Y1, Xiong W2, Lan X1, Zhang J1, Chen T1, Liu H1, Li G3.
• The Journal of surgical research.J Surg Res.2015 Feb;193(2):577-82. doi: 10.1016/j.jss.2014.07.064. Epub 2014 Aug 4.
• BACKGROUND: The single incision method through the umbilicus is commonly used for laparoscopic appendectomy. To obtain a better cosmetic outcome and less surgical complexity, we have designed a new single-incision laparoscopic appendectomy technique performed above the pubic symphysis.METHODS: Betwe
• PMID 25179807

• Clinical Health Service Research on the Surgical Therapy of Acute Appendicitis: Comparison of Outcomes Based on 3 German Multicenter Quality Assurance Studies Over 21 Years.

• Sahm M1, Pross M, Otto R, Koch A, Gastinger I, Lippert H.
• Annals of surgery.Ann Surg.2015 Jan 5. [Epub ahead of print]
• OBJECTIVE:: The treatment of acute appendicitis has seen changes in diagnosis and therapy in Germany. The objective of this analysis was to assess changes in therapy and outcome after open appendectomy (OA) and laparoscopic appendectomy (LA) over the last 21 years.BACKGROUND:: The analysis was based
• PMID 25563882

Japanese Journal

• インフルエンザ感染症に合併した急性虫垂炎の2小児例

• 加藤 正也,今高 城治,岡本 健太郎,谷 有希子,山口 岳史,荻野 恵,土岡 丘,加藤 広行,有阪 治
• Dokkyo journal of medical sciences 41(2), 173-176, 2014-07-25
• 症例1は6歳女児.インフルエンザ感染症初日に発熱しオセルタミビルを開始.第3病日,右下腹部に限局した圧痛が出現.腹部造影CTで糞石を認め急性虫垂炎と診断.保存的に加療し炎症反応と腹痛は改善した.症例2は5歳女児.第1病日に発熱と腹痛を認め,第3病日に鼻咽腔迅速検査でインフルエンザB型と診断しザナミビル吸入を開始.触診で右下腹部に反跳痛を認め,腹部単純CTで虫垂壁の肥厚と糞石を確認.急性虫垂炎の併発 …
• NAID 110009815884

• 症例 Interval appendectomyの1例

• 下田 陽太,関川 浩司,後藤 学 [他]
• 外科 = Surgey : 臨床雑誌 76(7), 783-786, 2014-07
• NAID 40020132518

• 症例報告 虫垂炎術後の遺残糞石による骨盤内膿瘍で治療に難渋した1例

• 上原 拓明,宮平 工,田嶋 公紀 [他]
• 日本外科感染症学会雑誌 11(3), 259-263, 2014-06
• NAID 40020158611

Related Links

• Appendectomyとは - goo Wikipedia (ウィキペディア)

An appendectomy (sometimes called appendisectomy or appendicectomy) is the surgical removal of the vermiform appendix. This procedure is normally performed as an emergency procedure, when the patient is suffering from acute appendicitis

• appendectomyの意味 - 英和辞書 - 英語辞書 - goo辞書

appendectomyとは。意味や和訳。[名][U][C]((主に米))《外科》虫垂切除（術）. - goo英和辞書は14万項目以上を収録し、発音、音声、慣用句、例文が分かる英和辞書です。

Related Pictures

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★リンクテーブル★

国試過去問	「109F025」
リンク元	「虫垂切除術」

「109F025」

　　[★]

• 44歳の男性。航空会社の職員に付き添われて空港内の診療所を受診した。持参した英文紹介状の一部を示す。
• This patient is a 44-year-old man with a complaint of right flank pain＊. The pain suddenly occurred while he was on the airplane. It was colicky and radiated to the right inguinal region. Neither nausea nor diarrhea was associated. He had appendectomy when he was 8 years old.
• Urinalysis results: Protein(-), Sugar(-), Occult blood(2+)
• ＊flank pain: lateral abdominal pain
• 出張のため近隣国へ向かう飛行機内で上記の症状を認めたため、到着直後に現地の空港内の診療所を受診し鎮痛薬を投与された。疼痛は我慢できる程度になり、予定を変更して次の便で日本に帰国した。現在、紹介状に書かれた症状は我慢できる程度に続いており、新たに生じた症状はない。意識は清明。身長 165cm、体重 68kg。体温 37.1℃。脈拍 76/分、整。血圧 136/76mmHg。
• この患者にみられる可能性の高い身体診察所見はどれか。

• a　腸雑音亢進
• b　陰嚢の透光性
• c　腹部血管雑音
• d　Blumberg徴候
• e　肋骨脊柱角の叩打痛

[正答]

E

※国試ナビ4※　［109F024］←［国試_109］→［109F026］

「虫垂切除術」

　　[★]

英

appendectomy, appendicectomy

同

虫垂切除