Krisher S L, Browne A, Dibbins A, Tkacz N, Curci M
Maine Medical Center, Portland, ME, USA.
Arch Surg. 2001 Apr;136(4):438-41. doi: 10.1001/archsurg.136.4.438.
The incidence of postoperative intra-abdominal abscess is higher after laparoscopic compared with open appendectomy for perforated appendicitis.
A historical cohort study of pediatric patients operated on for suspected appendicitis by open appendectomy or laparoscopic appendectomy compares the incidence of postoperative intra-abdominal abscess for each procedure.
A tertiary care center.
Five hundred thirty-eight pediatric patients were operated on for suspected appendicitis at our institution between 1974 and 1999. Of these, 453 were included in the study. Of the excluded patients, 9 had incomplete medical records, 69 had normal or interval appendectomies, and 7 had appendixes removed by methods other than laparoscopy or right lower quadrant incision.
Open appendectomy performed through a right lower quadrant incision or laparoscopic appendectomy performed through a 3-trocar approach by 1 of 3 pediatric surgeons at our institution.
The incidence of postoperative intra-abdominal abscess after laparoscopic vs open appendectomy.
In perforated appendicitis (170 patients), the incidence of postoperative abscess after laparoscopic appendectomy was 24% vs 4.2% after open appendectomy. The relative risk ratio of developing a postoperative abscess after perforated appendicitis was 5.6 (confidence interval, 2.1-16.0) after laparoscopic vs open appendectomy. The results remained significant when controlled for age, sex, intraoperative irrigation, and preoperative antibiotics. Postoperative abscess in all acute, gangrenous, and perforated appendicitis after laparoscopic appendectomy was 6.4% vs 3.0% after open appendectomy. This was not statistically significant.
There is a significant increase in the incidence of postoperative intra-abdominal abscess with perforated appendicitis after laparoscopic compared with open appendectomy in pediatric patients.
对于穿孔性阑尾炎，与开腹阑尾切除术相比，腹腔镜阑尾切除术后腹腔内脓肿的发生率更高。
一项针对因疑似阑尾炎接受开腹阑尾切除术或腹腔镜阑尾切除术的儿科患者的历史性队列研究，比较了每种手术术后腹腔内脓肿的发生率。
一家三级医疗中心。
1974年至1999年间，我院538例因疑似阑尾炎接受手术的儿科患者。其中，453例纳入研究。排除的患者中，9例病历不完整，69例行正常或间隔期阑尾切除术，7例阑尾通过腹腔镜或右下腹切口以外的方法切除。
由我院3名儿科外科医生之一通过右下腹切口进行开腹阑尾切除术，或通过三孔法进行腹腔镜阑尾切除术。
腹腔镜阑尾切除术与开腹阑尾切除术后腹腔内脓肿的发生率。
在穿孔性阑尾炎患者（170例）中，腹腔镜阑尾切除术后脓肿发生率为24%，开腹阑尾切除术后为4.2%。穿孔性阑尾炎术后发生脓肿的相对风险比，腹腔镜阑尾切除术与开腹阑尾切除术相比为5.6（置信区间，2.1 - 16.0）。在对年龄、性别、术中冲洗和术前抗生素进行控制后，结果仍然显著。腹腔镜阑尾切除术后所有急性、坏疽性和穿孔性阑尾炎的术后脓肿发生率为6.4%，开腹阑尾切除术后为3.0%。这无统计学意义。
在儿科患者中，与开腹阑尾切除术相比，腹腔镜阑尾切除术后穿孔性阑尾炎的腹腔内脓肿发生率显著增加。
