Sookpotarom Paiboon, Khampiwmar Wasana, Termwattanaphakdee Tanapron
Department of Surgery, Buddhachinaraj Hospital, Naresuan University, Phitsanulok, Thailand.
J Med Assoc Thai. 2010 Mar;93(3):318-23.
Although various protocols for the treatment of children with perforated appendicitis have been established, no one has cited incisional wound irrigation in detail.
The records of 69 children undergoing appendectomy for perforated appendicitis between 2004 and 2006 were reviewed. Wound irrigation prior to skin closure using 1-2 liters of normal saline was routinely performed in every case. The treatment protocol includes preoperative and postoperative antibiotic, early appendectomy, copious intraabdominal swab, vigorous wound irrigation and subcuticular skin closure. Either peritoneal lavage or transperitoneal drainage is omitted.
Mean patients' age was 8.7 years, 47.8% were girls and there was no death. Subcutaneous fat thickness averaged 1.3 cm. Mean duration of hospitalization was 5.8 days. Of 69 appendectomies, 47 had simple perforation and 22 developed complicated perforation. There were four post-op complications (5.8%). Two patients had very small seroma at the lateral margin of incision, which resolved without additional treatment. One boy developed adhesion obstruction and enterocutaneous fistula, postoperatively. The patient required reoperation and recovered uneventfully. Only one child had wound infection.
Vigorous wound irrigation followed by subcuticular skin closure for perforated appendicitis yields an acceptable outcome with low rate of wound complications.
尽管已经确立了多种治疗小儿穿孔性阑尾炎的方案，但尚未有人详细提及切口伤口冲洗。
回顾了2004年至2006年间69例行穿孔性阑尾炎阑尾切除术的儿童的病历。每例均在皮肤缝合前常规使用1 - 2升生理盐水进行伤口冲洗。治疗方案包括术前和术后使用抗生素、早期阑尾切除术、大量腹腔擦拭、积极的伤口冲洗和皮下皮肤缝合。省略了腹膜灌洗或经腹引流。
患者平均年龄为8.7岁，女孩占47.8%，无死亡病例。皮下脂肪厚度平均为1.3厘米。平均住院时间为5.8天。在69例阑尾切除术中，47例为单纯穿孔，22例发生复杂穿孔。术后有4例并发症（5.8%）。2例患者在切口外侧边缘有非常小的血清肿，未进行额外治疗即自行消退。1名男孩术后发生粘连性肠梗阻和肠皮肤瘘。该患者需要再次手术，术后恢复顺利。只有1名儿童发生伤口感染。
对于穿孔性阑尾炎，在积极进行伤口冲洗后采用皮下皮肤缝合，可获得可接受的结果，伤口并发症发生率较低。
