Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Langenbecks Arch Surg. 2011 Jan;396(1):63-8. doi: 10.1007/s00423-010-0709-z. Epub 2010 Sep 10.
Complicated acute appendicitis is still associated with an increased morbidity. If laparoscopy has been accepted as a valid approach, some questions remain concerning intra-abdominal abscess formation. Routine prophylactic drainage of the abdomen has been proposed. However, this practice remains a matter of debate, poorly validated in the literature. With the present study, we investigated the impact of drainage in laparoscopic appendectomy for complicated appendicitis.
This is a case match study of consecutive patients operated on by laparoscopy in a single institution. One hundred and thirty patients operated for complicated appendicitis (local peritonitis without perforation, with perforation, or with periappendicular abscess) with prophylactic intraperitoneal drainage were matched one by one to 130 patients operated without drainage. Uncomplicated appendicitis and generalized peritonitis were excluded. Primary endpoint was surgical complications and secondary endpoints were transit recovery time and length of hospital stay.
Patients without drain had significantly less overall complications (7.7% vs. 18.5%, p = 0.01). Moreover, the absence of drainage was of significant benefit for transit recovery time (2.5 vs. 3.5 days, p = 0.0068) and length of hospital stay (4.2 vs. 7.3 days, p < 0.0001).
No benefits were observed for prophylactic drainage of the abdominal cavity during emergency laparoscopic treatment of complicated appendicitis. For this reason, this practice may be abandoned.
复杂急性阑尾炎仍然与较高的发病率相关。如果腹腔镜已被接受为一种有效的方法，那么关于腹腔内脓肿形成的一些问题仍然存在。有人提出常规预防性腹腔引流。然而，这种做法在文献中仍然存在争议，没有得到很好的验证。本研究旨在探讨引流对腹腔镜治疗复杂阑尾炎的影响。
这是一项在单家机构进行的连续腹腔镜手术患者的病例匹配研究。130 例因复杂阑尾炎（局部腹膜炎无穿孔、穿孔或阑尾周围脓肿）行预防性腹腔内引流的患者与 130 例未行引流的患者进行一对一匹配。排除单纯性阑尾炎和弥漫性腹膜炎。主要终点是手术并发症，次要终点是中转恢复时间和住院时间。
未放置引流管的患者总体并发症发生率显著降低（7.7%比 18.5%，p = 0.01）。此外，引流的缺失对中转恢复时间（2.5 天比 3.5 天，p = 0.0068）和住院时间（4.2 天比 7.3 天，p < 0.0001）有显著的益处。
在急诊腹腔镜治疗复杂阑尾炎时，预防性腹腔引流没有益处。因此，这种做法可能被摒弃。
