Furuya Takeshi, Inoue Mikiya, Sugito Kiminobu, Goto Shumpei, Kawashima Hiroyuki, Kaneda Hide, Masuko Takayuki, Ohashi Kensuke, Ikeda Taro, Koshinaga Tsugumichi
Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610 Japan.
Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610 Japan ; Department of Pediatric Surgery, Teikyo University School of Medicine, Itabashi, Japan.
Indian J Surg. 2015 Dec;77(Suppl 3):1041-4. doi: 10.1007/s12262-014-1121-7. Epub 2014 Jun 17.
The management of patients with acute perforated appendicitis with abscess is controversial. The aim of the present study was to assess the outcomes of treatment in patients with this condition. We retrospectively analyzed 31 patients (16 men and 15 women with a mean age of 8.4 years) with appendicitis presenting with abscess. Patients were divided into two groups (emergency operation group and interval operation group), and clinical characteristics and outcomes of treatment were investigated. On presentation, no differences in gender, age, body weight, duration of symptoms, temperature, white blood cell count, C-reactive protein level, or maximum size of the abscess in the axial view were detected between the two groups. Fifteen patients (48.4 %) underwent emergency surgery. The remaining 16 patients (51.6 %) were initially treated conservatively with antibiotics. All 16 patients underwent planned operations after receiving conservative treatment, and two (12.5 %) of these patients underwent appendectomy before the planned operation day because of recurrent appendicitis without abscess. There were no differences in the length of hospital stay. In the emergency operation group, six (40 %) patients presented with wound infection and four (26.7 %) developed a postoperative intra-abdominal abscess. No infective complications were reported in the interval operation group. Interval appendectomy after conservative treatment of pediatric ruptured appendicitis with abscess significantly reduced postoperative infection rates.
急性穿孔性阑尾炎合并脓肿患者的治疗存在争议。本研究的目的是评估患有这种病症的患者的治疗结果。我们回顾性分析了31例患有阑尾炎合并脓肿的患者（16例男性和15例女性，平均年龄8.4岁）。患者被分为两组（急诊手术组和间隔手术组），并对临床特征和治疗结果进行了调查。在就诊时，两组在性别、年龄、体重、症状持续时间、体温、白细胞计数、C反应蛋白水平或脓肿在轴位视图中的最大尺寸方面均未检测到差异。15例患者（48.4%）接受了急诊手术。其余16例患者（51.6%）最初接受抗生素保守治疗。所有16例患者在接受保守治疗后均接受了计划性手术，其中2例（12.5%）患者因复发性阑尾炎但无脓肿在计划性手术日前接受了阑尾切除术。住院时间没有差异。在急诊手术组中，6例（40%）患者出现伤口感染，4例（26.7%）发生术后腹腔内脓肿。间隔手术组未报告感染性并发症。小儿穿孔性阑尾炎合并脓肿保守治疗后行间隔阑尾切除术可显著降低术后感染率。
