Pandit R K
Department of Surgery, Janaki Medical College, Janakpur, Nepal.
Kathmandu Univ Med J (KUMJ). 2016;14(55):210-214.
Background Early appendectomy in appendiceal mass is gaining popularity among some surgeons. However, it is endowed with increasing operative difficulty with time, and safe and feasible timing is not yet clear. Objective To know safe and feasible time limit for early appendectomy in appendiceal mass. Method This is a retrospective study. Between May 2009 and July 2014, 114 patients of appendiceal mass who underwent early surgical intervention by a single surgeon were studied. Group I included 98 patients operated within seven days of onset of pain and group II included 16 patients operated between 8th and 15 days of pain. Type of operative procedure, difficulties and complications were analyzed. Result There were 58 men and 56 women. Their mean age was 24.27 ± 8.7 years. In group I, 98 (100%) patients had appendectomy and adhesiolysis was safe and feasible. In group II, 5(31.25%) patients had extra-peritoneal drainage of abscess without attempt for appendectomy. Remaining 11 patients had attempt for appendectomy, but only 3(18.75%) out of 4 patients operated on the 8th day could have appendectomy. Six (37.5%) patients had just drainage of abscess. Two (12.5%) patients, operated on the 12th and 15th days of pain had just open-closed due to dense adhesion and both resolved. One patient operated on the 10th day sustained ileal injury. Surgical site infection occurred in 16.6% (14 in 86) in group I and 33.3% (5 in 15) in group B (P= 0.001). Mean operative time was 34.4 ± 9.23 minutes and 43.7 ± 16.38 minutes for group I and group II respectively. Mean hospital stay after surgery was 2.9 ± 1.1 days and 5.5 ± 1.37 days in group I and group II respectively. Conclusion Early appendectomy in appendiceal mass seems safe and feasible up to 7th day since onset of pain in my experience. However, this limit may vary with surgeon's experience, and further studies are required to better clarify this issue.
阑尾肿块早期行阑尾切除术在一些外科医生中越来越受欢迎。然而，随着时间推移，其手术难度不断增加，安全可行的手术时机尚不明确。目的：了解阑尾肿块早期阑尾切除术的安全可行时限。方法：这是一项回顾性研究。2009年5月至2014年7月，对114例由单一外科医生进行早期手术干预的阑尾肿块患者进行研究。第一组包括98例在疼痛发作7天内接受手术的患者，第二组包括16例在疼痛发作第8天至第15天接受手术的患者。分析手术方式、难度及并发症。结果：男性58例，女性56例。平均年龄24.27±8.7岁。第一组中，98例（100%）患者行阑尾切除术，粘连松解安全可行。第二组中，5例（31.25%）患者行脓肿腹膜外引流，未尝试行阑尾切除术。其余11例患者尝试行阑尾切除术，但在疼痛发作第8天手术的4例患者中，仅3例（18.75%）成功切除阑尾。6例（37.5%）患者仅行脓肿引流。2例（12.5%）在疼痛发作第12天和第15天接受手术的患者因粘连致密仅行开放闭合术，均康复。1例在疼痛发作第10天接受手术的患者发生回肠损伤。第一组手术部位感染发生率为16.6%（86例中有14例），第二组为33.3%（15例中有5例）（P = 0.001）。第一组和第二组的平均手术时间分别为34.4±9.23分钟和43.7±16.38分钟。第一组和第二组术后平均住院时间分别为2.9±1.1天和5.5±1.37天。结论：根据我的经验，阑尾肿块在疼痛发作后7天内行早期阑尾切除术似乎是安全可行的。然而，这一时限可能因外科医生的经验而异，需要进一步研究以更好地阐明这一问题。
