The Children's Mercy Hospital, Kansas City, MO, USA.
J Pediatr Surg. 2011 Dec;46(12):2346-8. doi: 10.1016/j.jpedsurg.2011.09.024.
Despite abundant data on the impact of obesity in adults, little data exist that examine the impact of obesity on surgical outcomes in children. Therefore, we analyzed the impact of obesity on children with perforated appendicitis.
We analyzed data from 3 prospective trials on perforated appendicitis between 2005 and 2009. Perforation was defined as a hole in the appendix or fecalith in the abdomen. There was no difference in abscess rate in the 6 arms of these trials. Body mass index (BMI) was calculated, and BMI percentile was identified according to sex and age. The obese group was defined as BMI greater than 95th percentile. Data were compared between nonobese and obese patients.
There were 220 patients, of which 37 patients were obese. The obese group was older with no other differences in presentation. Mean length of stay was 7.9 days in the obese patients compared with 5.8 days for the nonobese (P < .001). Mean operative time was 55.2 minutes in obese patients compared with 43.6 for nonobese (P = .003). Abscess rate was 35% in obese patients compared with 15% for nonobese (P = .01).
Obese children undergoing laparoscopic appendectomy for perforated appendicitis experience longer operative times and suffer worse outcomes.
尽管有大量关于成年人肥胖影响的数据，但很少有数据研究肥胖对儿童手术结果的影响。因此，我们分析了肥胖对患有穿孔性阑尾炎的儿童的影响。
我们分析了 2005 年至 2009 年间 3 项关于穿孔性阑尾炎的前瞻性试验的数据。穿孔定义为阑尾有孔或腹部有粪石。这些试验的 6 个治疗组之间的脓肿发生率没有差异。计算体重指数（BMI），并根据性别和年龄确定 BMI 百分位数。肥胖组定义为 BMI 大于第 95 百分位数。比较非肥胖组和肥胖组患者的数据。
共有 220 例患者，其中 37 例为肥胖患者。肥胖组年龄较大，但临床表现无其他差异。肥胖患者的住院时间平均为 7.9 天，而非肥胖患者为 5.8 天（P<0.001）。肥胖患者的手术时间平均为 55.2 分钟，而非肥胖患者为 43.6 分钟（P=0.003）。肥胖患者的脓肿发生率为 35%，而非肥胖患者为 15%（P=0.01）。
肥胖儿童行腹腔镜阑尾切除术治疗穿孔性阑尾炎，手术时间延长，预后较差。
