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基于单中心经验的儿童穿孔性阑尾炎阑尾切除术后引流管置入

Drain insertion after appendectomy in children with perforated appendicitis based on a single-center experience.

作者信息

Song Ra-Yeong, Jung Kyuwhan

机构信息

Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

出版信息

Ann Surg Treat Res. 2015 Jun;88(6):341-4. doi: 10.4174/astr.2015.88.6.341. Epub 2015 May 14.

Abstract

PURPOSE

Management of appendicitis in children has always been an issue in pediatric surgery. Both diagnostic methods and treatment vary significantly among medical centers, and little consensus exists in many aspects of the care for patients with appendicitis. Here, we assessed the value of drain insertion after appendectomy in children.

METHODS

This study is a retrospective review of pediatric patients who underwent appendectomy for perforated appendicitis at a tertiary medical center between 2003 and 2012. Patients who had a peritoneal drain inserted after appendectomy were compared with patients without drains regarding preoperative features and postoperative outcomes. Statistical analyses included a 2-tailed Student t-test and a chi-square or Fisher exact test.

RESULTS

In total, 958 patients were reviewed. Of 342 patients with perforated appendicitis, 108 (31.6%) had Jackson-Pratt (JP) drains inserted. The JP group had a longer hospital stay compared with the non-JP group (6.38 ± 3.59 days vs. 3.87 ± 2.38 days, P < 0.001). The JP group also had higher complication rates (22.2% vs. 6.8%, P = 0.003), including the formation of intra-abdominal abscesses.

CONCLUSION

According to our results, there seems to be little evidence to support peritoneal drain insertion after appendectomy, even in perforated appendicitis cases.

摘要

目的

儿童阑尾炎的治疗一直是小儿外科的一个问题。各医疗中心的诊断方法和治疗方式差异很大,在阑尾炎患者护理的许多方面几乎没有达成共识。在此,我们评估了儿童阑尾切除术后放置引流管的价值。

方法

本研究是对2003年至2012年期间在一家三级医疗中心因穿孔性阑尾炎接受阑尾切除术的儿科患者进行的回顾性研究。将阑尾切除术后放置腹腔引流管的患者与未放置引流管的患者在术前特征和术后结果方面进行比较。统计分析包括双尾Student t检验和卡方检验或Fisher精确检验。

结果

总共对958例患者进行了评估。在342例穿孔性阑尾炎患者中,108例(31.6%)放置了杰克逊-普拉特(JP)引流管。与未放置JP引流管的组相比,放置JP引流管的组住院时间更长(6.38±3.59天对3.87±2.38天,P<0.001)。放置JP引流管的组并发症发生率也更高(22.2%对6.8%,P=0.003),包括腹腔内脓肿的形成。

结论

根据我们的结果,似乎几乎没有证据支持阑尾切除术后放置腹腔引流管,即使在穿孔性阑尾炎病例中也是如此。

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