Tanaka Shogo, Ishihara Kanji, Uenishi Takahiro, Hashiba Ryoya, Kurashima Yukiko, Ohno Kohichi, Tanaka Sayaka, Ohsawa Masahiko, Yamamoto Takatsugu
Department of Surgery, Ishikiriseiki Hospital, Higashiosaka City, Japan.
Osaka City Med J. 2013 Jun;59(1):1-7.
Complicated appendicitis (gangrenous or perforated appendicitis) is a risk for postoperative intraabdominal abscess, but management of intraabdominal abscess may differ between laparoscopic and open appendectomy.
We reviewed 67 patients who underwent appendectomy for complicated appendicitis, including 26 who received laparoscopic appendectomy (LA group) and 41 who underwent open appendectomy (OA group). The operation was performed under general anesthesia in all 26 patients in the LA group and in 10 (24%) in the OA group. Patient characteristics, operative factors, and postoperative complications (especially postoperative intraabdominal abscess) were compared between the two groups. Management of postoperative intraabdominal abscess was also investigated.
Postoperative intraabdominal abscess occurred in 3 patients (12%) in the LA group and in 10 (24%) in the OA group (p = 0.23). All 3 patients in the LA group were treated conservatively. Of the 10 patients in the OA group, 6 were treated conservatively, but 4 needed a reoperation, including 3 who had undergone right pararectal skin incision under spinal analgesia and in whom sufficient irrigation was not possible because anesthesia had worn off.
Our results suggest that insertion of abdominal drainage may be appropriate treatment for intraabdominal abscess after laparoscopic appendectomy. Light anesthesia may induce residual abscess in open appendectomy performed under spinal analgesia.
复杂性阑尾炎（坏疽性或穿孔性阑尾炎）有术后腹腔内脓肿形成的风险，但腹腔镜阑尾切除术和开腹阑尾切除术对腹腔内脓肿的处理可能有所不同。
我们回顾了67例行复杂性阑尾炎阑尾切除术的患者，其中26例行腹腔镜阑尾切除术（LA组），41例行开腹阑尾切除术（OA组）。LA组的26例患者及OA组的10例（24%）患者在全身麻醉下进行手术。比较两组患者的特征、手术因素及术后并发症（尤其是术后腹腔内脓肿）。还对术后腹腔内脓肿的处理进行了研究。
LA组有3例患者（12%）发生术后腹腔内脓肿，OA组有10例（24%）发生（p = 0.23）。LA组的3例患者均接受保守治疗。OA组的10例患者中，6例接受保守治疗，但4例需要再次手术，其中3例在脊麻下行右直肠旁皮肤切口，因麻醉失效无法充分冲洗。
我们的结果表明，腹腔镜阑尾切除术后腹腔内脓肿插入腹腔引流可能是合适的治疗方法。浅麻醉可能会在脊麻下行开腹阑尾切除术后导致残余脓肿。
