Department of Surgery, University of Hawaii Surgical Residency Program, Honolulu, HI 96813, USA.
J Pediatr Surg. 2011 Jul;46(7):1385-9. doi: 10.1016/j.jpedsurg.2011.01.003.
Postoperative abscesses after appendectomy occur in 3% to 20% of cases and are more common in cases of perforated appendicitis. Smaller abscesses are often amenable to antibiotic therapy, but surgical drainage remains the mainstay of treatment for larger collections. Surgical options generally include percutaneous drainage and open laparotomy. Laparoscopic drainage of these abscesses has not been well characterized in the pediatric population.
The aim of this study was to describe our experience with laparoscopic drainage of postappendectomy abscesses that were not amenable to percutaneous drainage.
This study is a retrospective review of all pediatric patients who underwent laparoscopic appendectomy for acute appendicitis at a tertiary pediatric medical center during a 4-year period (2006-2009). The review focuses on patients who developed abscesses after appendectomy, were unable to undergo percutaneous drainage, and were treated with laparoscopic abscess drainage.
Twelve patients (7 male and 5 female) underwent laparoscopic drainage of postappendectomy abscesses. The mean age was 8.5 years old (range, 3-14 years). A clinical diagnosis of postoperative abscess was made when fevers, pain, and leukocytosis persisted despite broad-spectrum antibiotics. Computed tomography was performed in all patients. Abscesses ranged between 3 and 11 cm in size. The mean length of time between initial appendectomy and drainage procedure was 10 days. There were no complications specifically related to the laparoscopic drainage procedure. The mean length of the drainage procedure was 77 minutes (range, 30-196 minutes). The mean hospital length of stay after laparoscopic drainage was 6.5 days (range, 3-13 days) with patients maintained on intravenous antibiotics until afebrile and without leukocytosis.
Laparoscopic drainage is a safe and effective alternative for intraabdominal abscesses that occur after laparoscopic appendectomy. We recommend it as an alternative to open laparotomy when percutaneous drainage is not an option.
阑尾切除术后脓肿的发生率为 3%至 20%，在穿孔性阑尾炎病例中更为常见。较小的脓肿通常适合抗生素治疗，但对于较大的脓肿，手术引流仍然是主要的治疗方法。手术选择通常包括经皮引流和剖腹手术。腹腔镜引流在儿科人群中的应用尚未得到很好的描述。
本研究旨在描述我们对不适合经皮引流的阑尾切除术后脓肿进行腹腔镜引流的经验。
本研究是对一家三级儿科医疗中心在 4 年期间（2006-2009 年）接受腹腔镜阑尾切除术治疗急性阑尾炎的所有儿科患者进行的回顾性研究。该研究重点关注阑尾切除术后发生脓肿、无法进行经皮引流且接受腹腔镜脓肿引流治疗的患者。
12 名患者（7 名男性和 5 名女性）接受了腹腔镜引流阑尾切除术后脓肿。平均年龄为 8.5 岁（范围，3-14 岁）。当发热、疼痛和白细胞增多持续存在，尽管使用了广谱抗生素后，临床诊断为术后脓肿。所有患者均行 CT 检查。脓肿大小为 3-11cm 不等。初始阑尾切除术后至引流手术的平均时间为 10 天。无与腹腔镜引流手术相关的特定并发症。引流手术的平均时间为 77 分钟（范围，30-196 分钟）。腹腔镜引流后平均住院时间为 6.5 天（范围，3-13 天），患者在发热和白细胞计数正常之前持续接受静脉抗生素治疗。
腹腔镜引流是一种安全有效的方法，适用于腹腔镜阑尾切除术后发生的腹腔脓肿。当经皮引流不可行时，我们建议将其作为剖腹手术的替代方法。
