Serradilla J, Bueno A, De la Torre C, Domínguez E, Sánchez A, Nava B, Álvarez M, López Santamaría M, Martínez L
Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid.
Cir Pediatr. 2018 Feb 1;31(1):25-28.
Acute appendicitis is the most frequent surgical urgency in children. Frequently, it can be complicated with an intraabdominal abscess that will require a longer and expensive treatment. Our aim is to know if it is possible to predict this complication before its beginning.
Retrospective case-control study with patients treated between 2011 and 2016, paired according to their own characteristics (age, sex and weight), clinical aspects (symptoms, time of their onset, physical examination) and type of appendicitis (gangrenous). The main variable was the appearance of an intraabdominal abscess in the postoperative period (cases). Univariate and multivariate analysis were performed, with a statistical significance level of p < 0.05.
We included 54 cases and 108 controls. The occurrence of intraabdominal abscess was significantly associated with preoperative hyponatremia (p < 0.001), elevated CRP (p < 0.05), appendix perforation (p < 0.001) and wound infection (p < 0.001). The multivariate analysis dismissed the value of the CRP as an abscess predictor but showed association in the other three variables cited before. There was no association with the presence of generalized peritonitis at the intervention or the type of surgical approach.
Appendix perforation, infection of the surgical wound and hyponatremia at diagnosis are predictive factors for the appearance of a postoperative intraabdominal abscess after acute gangrene appendicitis. We believe that early identification would favor the secondary prevention of this complication and the decrease of its morbidity.
急性阑尾炎是儿童最常见的外科急症。它常并发腹腔内脓肿，需要更长时间且费用更高的治疗。我们的目的是了解是否有可能在该并发症发生前进行预测。
对2011年至2016年期间接受治疗的患者进行回顾性病例对照研究，根据患者自身特征（年龄、性别和体重）、临床情况（症状、发病时间、体格检查）和阑尾炎类型（坏疽性）进行配对。主要变量是术后腹腔内脓肿的出现（病例组）。进行单因素和多因素分析，统计学显著性水平为p < 0.05。
我们纳入了54例病例和108例对照。腹腔内脓肿的发生与术前低钠血症（p < 0.001）、CRP升高（p < 0.05）、阑尾穿孔（p < 0.001）和伤口感染（p < 0.001）显著相关。多因素分析排除了CRP作为脓肿预测指标的价值，但显示出与之前提到的其他三个变量有关联。与干预时是否存在弥漫性腹膜炎或手术方式无关。
阑尾穿孔、手术伤口感染和诊断时的低钠血症是急性坏疽性阑尾炎术后腹腔内脓肿出现的预测因素。我们认为早期识别将有助于对该并发症进行二级预防并降低其发病率。
