Agrawal Vikesh, Acharya Himanshu, Chanchlani Roshan, Sharma Dhananjaya
Department of Pediatric Surgery, Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, Madhya Pradesh, India.
Department of Surgery, Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, Madhya Pradesh, India.
J Minim Access Surg. 2016 Apr-Jun;12(2):98-101. doi: 10.4103/0972-9941.178518.
Early appendicectomy has been found to be a safe and better alternative for management of appendicular mass in various studies in adults, while very few studies report such advantages in the paediatric population. We conducted this study to assess the safety, efficacy and need of early laparoscopic appendicectomy (ELA) in child patients with appendicular mass.
All patients with appendicular mass who underwent ELA at our institute between September 2011 and August 2014 were retrospectively reviewed. Appendicular mass was defined as a right iliac fossa mass in a case of acute appendicitis, diagnosed by clinical, laboratory and radiological evaluation, and palpation under anaesthesia, the patient being subjected to laparoscopic treatment.
Forty-eight (48) patients were confirmed to have appendicular mass intraoperatively and were included in the analysis. There were 30 males and 18 females, with ages ranging 7-13 years (mean 9 years). In the present study, appendicular complications included appendicular abscess (62.5%), gangrenous appendicitis (25%), sloughed-out appendix (8.33%) and appendicular perforation (4.16%). The average operative time was 72 min (range 45-93 min). One case (1.92%) required conversion to open procedure due to failure of identification of the appendicular base of a sloughed-out appendix. Post-operative complications were found in 4 (7.69%) patients, of whom 3 (5.76%) had minor wound infection at the umbilical port site and 1 (1.92%) had post-operative pelvic abscess, which was managed with percutaneous aspiration.
ELA avoids misdiagnosis, treats complicated appendicitis at its outset, and avoids complications and/or failure of non-operative treatment of a potentially lethal, diseased appendix. This approach is associated with minimal complications in experienced hands and is a safe and feasible option in children with appendicular mass.
在针对成人的多项研究中，早期阑尾切除术已被证明是治疗阑尾周围脓肿的一种安全且更佳的选择，而在儿科人群中报告有此类优势的研究极少。我们开展这项研究以评估早期腹腔镜阑尾切除术（ELA）在患有阑尾周围脓肿的儿童患者中的安全性、有效性及必要性。
对2011年9月至2014年8月间在我院接受ELA的所有阑尾周围脓肿患者进行回顾性分析。阑尾周围脓肿定义为急性阑尾炎患者右下腹的包块，通过临床、实验室及影像学评估以及麻醉下触诊确诊，患者接受腹腔镜治疗。
48例患者术中确诊为阑尾周围脓肿并纳入分析。其中男性30例，女性18例，年龄7 - 13岁（平均9岁）。在本研究中，阑尾相关并发症包括阑尾脓肿（62.5%）、坏疽性阑尾炎（25%）、阑尾脱落（8.33%）及阑尾穿孔（4.16%）。平均手术时间为72分钟（范围45 - 93分钟）。1例（1.92%）因阑尾脱落无法辨认阑尾根部而转为开放手术。4例（7.69%）患者出现术后并发症，其中3例（5.76%）在脐部切口处有轻微伤口感染，1例（1.92%）有术后盆腔脓肿，经皮穿刺抽吸治疗。
ELA可避免误诊，从一开始就治疗复杂阑尾炎，避免潜在致命性病变阑尾非手术治疗的并发症和/或失败。在经验丰富的医生操作下，这种方法并发症极少，对于患有阑尾周围脓肿的儿童是一种安全可行的选择。
