Tsai Hsin-Yu, Chao Hsun-Chin, Yu Wan-Ju
Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Guishan District, Taoyuan City, Taiwan.
Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Guishan District, Taoyuan City, Taiwan.
Pediatr Neonatol. 2017 Oct;58(5):406-414. doi: 10.1016/j.pedneo.2016.09.001. Epub 2017 Feb 1.
The optimal management of perforated appendicitis in the pediatric population has been controversial. This study aimed to compare the therapeutic efficacy between conservative treatment (CS) and early appendectomy (EA) in pediatric perforated appendicitis, and to determine whether surgical intervention is an optimal treatment modality for early perforated appendicitis in children.
Patients treated between January 2012 and April 2014, aged 0-18 years, with an imaging-based diagnosis of perforated appendicitis were retrospectively reviewed. Patients were classified into nonabscess and abscess groups by image findings, and were further categorized into CS and EA groups by treatment modality. Early perforated appendicitis was defined as having duration of symptoms≤7 days, C-reactive protein level≤200 mg/L, maximum abscess diameter≤5 cm, and absence of general peritonitis, and unstable vital signs. The clinical features and therapeutic outcomes were compared between CS and EA in each group.
A total of 326 patients had confirmed appendicitis, including 116 patients with an image diagnosis of perforation. The CS group had a significantly longer duration of symptoms, larger abscesses, and higher serum C-reactive protein levels at presentation (all p<0.05). Patients in the EA group had a shorter antibiotic course and length of hospitalization, and a lower rate of antibiotic escalation than those in the CS group (p<0.001, p<0.001, and p<0.05, respectively). In patients with early perforated appendicitis, the CS and EA groups showed no difference in baseline disease severity. Patients in the EA group also had a shorter antibiotic course and length of hospitalization than those in the CS group (p<0.001 and p<0.001, respectively).
Compared with CS, EA shortens the antibiotic course and hospital stay in pediatric early perforated appendicitis, even in the presence of small abscesses.
小儿穿孔性阑尾炎的最佳治疗方案一直存在争议。本研究旨在比较保守治疗（CS）与早期阑尾切除术（EA）在小儿穿孔性阑尾炎中的治疗效果，并确定手术干预是否为小儿早期穿孔性阑尾炎的最佳治疗方式。
回顾性分析2012年1月至2014年4月间年龄在0至18岁、经影像学诊断为穿孔性阑尾炎的患者。根据影像检查结果将患者分为非脓肿组和脓肿组，并根据治疗方式进一步分为CS组和EA组。早期穿孔性阑尾炎定义为症状持续时间≤7天、C反应蛋白水平≤200mg/L、最大脓肿直径≤5cm、无弥漫性腹膜炎且生命体征稳定。比较每组中CS组和EA组的临床特征及治疗结果。
共有326例患者确诊为阑尾炎，其中116例经影像学诊断为穿孔。CS组患者就诊时症状持续时间显著更长、脓肿更大、血清C反应蛋白水平更高（均p<0.05）。与CS组相比，EA组患者抗生素疗程更短、住院时间更短、抗生素升级率更低（分别为p<0.001、p<0.001和p<0.05）。在早期穿孔性阑尾炎患者中，CS组和EA组在基线疾病严重程度方面无差异。与CS组相比，EA组患者抗生素疗程和住院时间也更短（分别为p<0.001和p<0.001）。
与CS相比，EA可缩短小儿早期穿孔性阑尾炎的抗生素疗程和住院时间，即使存在小脓肿时亦是如此。
