Aprahamian Charles J, Barnhart Douglas C, Bledsoe Samuel E, Vaid Yoginder, Harmon Carroll M
Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
J Pediatr Surg. 2007 Jun;42(6):934-8; discussion 938. doi: 10.1016/j.jpedsurg.2007.01.024.
The initial nonoperative management of perforated appendicitis fails in 15% to 25% of children. These children have complications and increased hospitalization. The purpose of this study was to identify predictors of failure.
Children with perforated appendicitis treated with antibiotics and intent for nonoperative management over a 4-year period were reviewed. Seventy-five children were identified and included in the study. Failure was defined as undergoing appendectomy before the initially planned interval.
Nine (12%) of the patients required appendectomy sooner than initially planned. Age, presenting symptoms, physical examination findings, and white blood cell (WBC) count were similar in both success and failure groups. Absence of abscess and presence of appendicolith were both predictors of failure in a multivariate analysis, which included the presence of small bowel obstruction. The failed group had a longer median total length of stay (18 days [range, 4-67] vs 8 days [range, 4-31]; P = .002) and underwent 3 times as many computed tomography scans as successes (3 [range, 2-7] vs 1 [range, 0-5]; P < .001).
Lack of abscess and presence of an appendicolith predict failure of nonoperative management of perforated appendicitis in children even when the effect of small bowel obstruction is accounted for. Children with these characteristics may benefit from alternative management strategies.
小儿穿孔性阑尾炎的初始非手术治疗在15%至25%的患儿中失败。这些患儿会出现并发症且住院时间延长。本研究的目的是确定治疗失败的预测因素。
回顾了4年间接受抗生素治疗且打算进行非手术治疗的穿孔性阑尾炎患儿。共确定75例患儿并纳入研究。治疗失败定义为在最初计划的间隔时间之前接受阑尾切除术。
9例（12%）患者比最初计划的时间更早接受了阑尾切除术。成功组和失败组在年龄、症状表现、体格检查结果及白细胞计数方面相似。在多因素分析中，无脓肿和存在阑尾结石均为治疗失败的预测因素，该分析纳入了小肠梗阻情况。失败组的中位总住院时间更长（18天[范围4 - 67天] vs 8天[范围4 - 31天]；P = 0.002），且失败组接受计算机断层扫描的次数是成功组的3倍（3次[范围2 - 7次] vs 1次[范围0 - 5次]；P < 0.001）。
即使考虑小肠梗阻的影响，无脓肿和存在阑尾结石仍可预测小儿穿孔性阑尾炎非手术治疗的失败。具有这些特征的患儿可能从其他治疗策略中获益。
