Reid R I, Dobbs B R, Frizelle F A
Department of Surgery, Christchurch School of Medicine and Hospital, New Zealand.
Aust N Z J Surg. 1999 May;69(5):373-4. doi: 10.1046/j.1440-1622.1999.01576.x.
Appendicectomy is a common emergency operation, after which major complications are uncommon, however when they do occur they are a major cause of concern to patient and surgeon. This study aims to determine the incidence and risk factors for post-appendicectomy intra-abdominal abscess formation.
A retrospective review was undertaken of all appendicectomies undertaken in Christchurch Hospital between 1 January and 31 December 1995. Appendicectomies were identified from a database of histology. The patients' notes were reviewed and the surgical approach, histological diagnosis and postoperative complications identified.
A total of 417 appendicectomies was identified of which 331 were open, 66 laparoscopic, and 20 undertaken at laparotomy. Mean day stays for each group were 4.4, 4.2 and 11.5 days, respectively. The percentages of patients with acute appendicitis in each group were 87, 58 and 35%. Histologically the appendix was inflamed in 80% (334) of patients (acute 232, chronic 15, perforated 56 and gangrenous 24). There were six postoperative intra-abdominal abscesses (1.4%), all occurring in the open appendicectomy group when the histology was either perforated or gangrenous appendicitis (P < 0.001). There were no cases of postoperative abscess formation following laparoscopic appendicectomy. All cases of postoperative intra-abdominal abscess were associated with perforated and/or gangrenous appendicitis (P < 0.001). The incidence of intra-abdominal abscesses was 7.5% with a perforated and/or gangrenous appendix. There were two cases of iatrogenic perforation following laparoscopic appendicectomy.
The incidence of intra-abdominal abscess is 1.4% of all appendicectomies. The only identified risk factor for development of post-appendicectomy intra-abdominal abscess was the underlying pathology of gangrenous or perforated appendicitis.
阑尾切除术是一种常见的急诊手术，术后严重并发症并不常见，然而一旦发生，会引起患者和外科医生的高度关注。本研究旨在确定阑尾切除术后腹腔内脓肿形成的发生率及危险因素。
对1995年1月1日至12月31日在克赖斯特彻奇医院进行的所有阑尾切除术进行回顾性研究。阑尾切除术通过组织学数据库进行识别。查阅患者病历，确定手术方式、组织学诊断及术后并发症。
共识别出417例阑尾切除术，其中331例为开放手术，66例为腹腔镜手术，20例为剖腹手术。每组的平均住院天数分别为4.4天、4.2天和11.5天。每组急性阑尾炎患者的百分比分别为87%、58%和35%。组织学检查显示，80%（334例）患者的阑尾有炎症（急性232例、慢性15例、穿孔56例、坏疽24例）。术后有6例腹腔内脓肿（1.4%），均发生在开放阑尾切除术组，组织学检查为穿孔性或坏疽性阑尾炎（P<0.001）。腹腔镜阑尾切除术后无术后脓肿形成病例。所有术后腹腔内脓肿病例均与穿孔性和/或坏疽性阑尾炎有关（P<0.001）。穿孔性和/或坏疽性阑尾的腹腔内脓肿发生率为7.5%。腹腔镜阑尾切除术后有2例医源性穿孔。
腹腔内脓肿的发生率占所有阑尾切除术的1.4%。阑尾切除术后腹腔内脓肿形成的唯一确定危险因素是坏疽性或穿孔性阑尾炎的潜在病理情况。
