Brown Carlos V R, Abrishami Michael, Muller Matthew, Velmahos George C
Department of Surgery, University of Southern California, Los Angeles County/USC Medical Center, Los Angeles, California 90033, USA.
Am Surg. 2003 Oct;69(10):829-32.
Conflicting evidence exists regarding the optimal treatment for abscess complicating acute appendicitis. The objective of this study is to compare immediate appendectomy (IMM APP) versus expectant management (EXP MAN) including percutaneous drainage with or without interval appendectomy to treat periappendiceal abscess. One hundred four patients with acute appendicitis complicated by periappendiceal abscess were identified. We compared 36 patients who underwent IMM APP with 68 patients who underwent EXP MAN. Outcome measures included morbidity and length of hospital stay. The groups were similar with regard to age (30.6 +/- 12.3 vs. 34.8 +/- 13.5 years), gender (61% vs. 62% males), admission WBC count (17.5 +/- 5.1 x 10(3) vs. 17.0 +/- 4.8 x 10(3) cells/dL), and admission temperature (37.9 +/- 1.2 vs. 37.8 +/- 0.9 degrees F). IMM APP patients had a higher rate of complications than EXP MAN patients at initial hospitalization (58% vs. 15%, P < 0.001) and for all hospitalizations (67% vs. 24%, P < 0.001). The IMM APP group also had a longer initial (14.8 +/- 16.1 vs. 9.0 +/- 4.8 days, P = 0.01) and overall hospital stay (15.3 +/- 16.2 vs. 10.7 +/- 5.4 days, P = 0.04). We conclude that percutaneous drainage and interval appendectomy is preferable to immediate appendectomy for treatment of appendiceal abscess because it leads to a lower complication rate and a shorter hospital stay.
关于急性阑尾炎并发脓肿的最佳治疗方法，存在相互矛盾的证据。本研究的目的是比较即刻阑尾切除术（IMM APP）与期待治疗（EXP MAN），后者包括经皮引流以及是否进行间隔期阑尾切除术，以治疗阑尾周围脓肿。共纳入104例急性阑尾炎并发阑尾周围脓肿的患者。我们将36例行IMM APP的患者与68例行EXP MAN的患者进行了比较。观察指标包括发病率和住院时间。两组在年龄（30.6±12.3岁 vs. 34.8±13.5岁）、性别（男性分别为61%和62%）、入院时白细胞计数（17.5±5.1×10³ vs. 17.0±4.8×10³个/微升）以及入院时体温（37.9±1.2 vs. 37.8±0.9华氏度）方面相似。IMM APP组患者在首次住院时（58% vs. 15%，P<0.001）以及所有住院期间（67% vs. 24%，P<0.001）的并发症发生率均高于EXP MAN组。IMM APP组的初始住院时间（14.8±16.1天 vs. 9.0±4.8天，P = 0.01）和总住院时间（15.3±16.2天 vs. 10.7±5.4天，P = 0.04）也更长。我们得出结论，对于阑尾脓肿的治疗，经皮引流和间隔期阑尾切除术优于即刻阑尾切除术，因为它能降低并发症发生率并缩短住院时间。
