成人急性阑尾炎的日间手术：102例患者的前瞻性系列研究

Day Surgery for Acute Appendicitis in Adults: A Prospective Series of 102 Patients.

作者信息

Hobeika Christian, Hor Thevy, Chereau Nathalie, Laforest Anais, Bachmann Radu, Sourouille Isabelle, Chafai Najim, Parc Yann, Beaussier Marc, Lefèvre Jérémie H

机构信息

*Department of General and Digestive Surgery, Hôpital Saint Antoine (AP-HP), Paris VI University †Department of General and Digestive Surgery, Hôpital Kremlin-Bicetre (AP-HP), Paris XI University, Paris, France.

出版信息

Surg Laparosc Endosc Percutan Tech. 2017 Jun;27(3):158-162. doi: 10.1097/SLE.0000000000000394.

DOI:10.1097/SLE.0000000000000394

PMID:28346288

Abstract

AIM

To report the results of a consecutive series of day surgery appendectomy (DSA) for acute appendicitis.

METHODS

Selection criteria for DSA were as follows: body mass index<28 kg/m, white cell count <15,000/mL, C-reactive protein<30 mg/L, no radiological signs of perforation, and appendix diameter ≤10 mm. All patients with radiologically proven appendicitis and 4 or 5 criteria were proposed for DSA and prospectively included.

RESULTS

A total of 102 patients (female=39.2%) were operated between January 1, 2013 and January 5, 2015 with a median age of 29.5 years [interquartile range (IQR), 23 to 37 y]. Diagnosis was mainly supported by computed tomographic scan (75.5%). About 60 patients (59%) were reconvened on the next morning for surgery with oral antibiotics. The median operative time was 40 minutes (IQR, 30 to 52 min), and 92 (90%) patients were discharged on day 0 after a postoperative period of 5h:12min (IQR, 4h:14min to 6h:33min). The overall median hospital length of stay was 8h:04min (IQR, 6h:46min to 10h:23min). Surgical morbidity was 6.9% (n=7), with 1.9% (n=2) major complications.

CONCLUSIONS

DSA is a safe procedure for selected patients; it reduces the hospital length of stay without increasing morbidity.

摘要

目的

报告一系列连续性急性阑尾炎日间手术阑尾切除术（DSA）的结果。

方法

DSA的选择标准如下：体重指数<28kg/m²，白细胞计数<15000/mL，C反应蛋白<30mg/L，无穿孔的放射学征象，阑尾直径≤10mm。所有经放射学证实为阑尾炎且符合4项或5项标准的患者均被建议行DSA并前瞻性纳入研究。

结果

2013年1月1日至2015年1月5日期间，共对102例患者（女性占39.2%）进行了手术，中位年龄为29.5岁[四分位间距（IQR），23至37岁]。诊断主要依靠计算机断层扫描（75.5%）。约60例患者（59%）次日早晨再次入院接受口服抗生素治疗后进行手术。中位手术时间为40分钟（IQR，30至52分钟），92例（90%）患者在术后5小时12分钟（IQR，4小时14分钟至6小时33分钟）后于第0天出院。总体中位住院时间为8小时04分钟（IQR，6小时46分钟至10小时23分钟）。手术并发症发生率为6.9%（n = 7），其中严重并发症发生率为1.9%（n = 2）。