Neilson I R, Laberge J M, Nguyen L T, Moir C, Doody D, Sonnino R E, Youssef S, Guttman F M
Department of Pediatric Surgery, Montreal Children's Hospital, Quebec, Canada.
J Pediatr Surg. 1990 Nov;25(11):1113-6. doi: 10.1016/0022-3468(90)90742-r.
Wound infection is the most common source of morbidity in appendicitis. Most recent pediatric series use protocols of preoperative antibiotics with aerobic and anaerobic coverage, intraoperative lavage, no peritoneal or wound drains, and continuation of antibiotics postoperatively with complicated appendicitis. There still remains controversy concerning skin closure and the duration of antibiotic therapy. We report the results of a prospective protocol followed over 2 years with 420 children. The protocol was designed to determine whether the skin could be closed primarily in all patients undergoing appendectomy. Preoperatively all patients received triple antibiotics (ampicillin, gentamicin, and clindamycin) that were continued postoperatively for two doses if there was a normal appendix or simple acute appendicitis, for at least 3 days with gangrenous appendicitis, and at least 5 days with perforated appendicitis. Antibiotics were continued if the patient remained febrile or had a white count greater than 10,000. No drains were used and the skin was closed primarily. The overall infectious complication rate was 1.0% (4/420). Among those with a normal appendix or simple acute appendicitis there were no infectious complications. Among those with gangrenous or perforated appendicitis there were 1.7% wound infections (2/117) and 1.7% intraabdominal abscesses (2/117). Duration of hospitalization was 2.1 days (range, 1 to 5 days) after simple acute appendicitis and 6.9 days (range, 3 to 40 days) after gangrenous or perforated appendicitis. These results set new standards in terms of wound management, infectious complications, and length of hospital stay.
伤口感染是阑尾炎最常见的发病原因。最近的儿科系列研究采用了术前使用覆盖需氧菌和厌氧菌的抗生素方案、术中冲洗、不放置腹腔或伤口引流管以及对复杂阑尾炎术后继续使用抗生素的方法。关于皮肤缝合和抗生素治疗持续时间仍存在争议。我们报告了一项对420名儿童进行的为期2年的前瞻性方案的结果。该方案旨在确定所有接受阑尾切除术的患者是否都能一期缝合皮肤。术前所有患者均接受三联抗生素（氨苄西林、庆大霉素和克林霉素）治疗，如果阑尾正常或为单纯急性阑尾炎，术后继续使用两剂；如果是坏疽性阑尾炎，则至少使用3天；如果是穿孔性阑尾炎，则至少使用5天。如果患者仍发热或白细胞计数大于10000，则继续使用抗生素。不放置引流管，皮肤一期缝合。总的感染并发症发生率为1.0%（4/420）。阑尾正常或为单纯急性阑尾炎的患者中无感染并发症。坏疽性或穿孔性阑尾炎患者中伤口感染率为1.7%（2/117），腹腔脓肿率为1.7%（2/117）。单纯急性阑尾炎后的住院时间为2.1天（范围1至5天），坏疽性或穿孔性阑尾炎后的住院时间为6.9天（范围3至40天）。这些结果在伤口处理、感染并发症和住院时间方面设定了新的标准。
