Bhatt N R, Dunne E, Faraz M, Gillis A E, Conlon K C, Paran S, Ridgway P F
Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland.
Department of Surgery, Trinity College Dublin, Tallaght University Hospital, Dublin 24, Ireland.
World J Surg. 2018 Nov;42(11):3792-3802. doi: 10.1007/s00268-018-4688-5.
In adult patients, it is generally accepted that laparoscopic appendicectomy (LA) is the predominant operative pathway in treating acute appendicitis. The case for a similar pathway utilising LA in children is less clear. We investigate usage, trends and complications after LA in children in a single co-located adult/paediatric centre with contemporaneous adults as controls.
A retrospective case-control study was conducted over 12 years including patients who underwent appendicectomy, and the paediatric series (<16 years) was divided into age-groups-based quartiles. An anonymous questionnaire-based national survey was circulated among general and paediatric surgeons.
Of the 5784 appendicectomy patients, 2960 were children. LA rate in paediatric appendicitis was 65%. Yearly trends in LA reached a steady state in both groups after 2010 (Δ 0-1%/year). Rates of LA and LA IAA (respectively) differed significantly between age groups: 60, 3% (0-9 years); 65, 1% (10-13 years); 71, 2% (14-16 years) and 93, 3% (>16 years) (p = 0.001, 0.02). The national survey showed respondents believed LA was not superior to OA in paediatric patients except in terms of cosmesis. There was strong support in the use of LA in older children and children >40 kg.
The use of LA in paediatric appendicectomies in the study region is similar to international rates, but not increasing over time. Irish surgeons still favour OA in younger children and prefer a case-by-case approach rather LA being the preferred pathway. This is despite the regional and international evidence showing favourable outcomes with LA in children.
在成年患者中，腹腔镜阑尾切除术（LA）是治疗急性阑尾炎的主要手术方式，这一点已得到广泛认可。而在儿童中采用类似LA手术方式的情况尚不清楚。我们在一个同时设有成人/儿科科室的中心进行研究，以同期的成年患者作为对照，调查儿童LA术后的使用情况、趋势及并发症。
进行了一项为期12年的回顾性病例对照研究，纳入接受阑尾切除术的患者，儿科组（<16岁）按年龄分为四分位数组。向普通外科医生和儿科外科医生发放了一份基于匿名问卷的全国性调查问卷。
在5784例阑尾切除术患者中，2960例为儿童。儿童阑尾炎的LA率为65%。2010年后，两组的LA年度趋势均达到稳定状态（每年变化0 - 1%）。不同年龄组的LA率和LA伴腹腔内脓肿（LA IAA）率存在显著差异：60, 3%（0 - 9岁）；65, 1%（10 - 13岁）；71, 2%（14 - 16岁）和93, 3%（>16岁）（p = 0.001, 0.02）。全国性调查显示，受访者认为除了美观方面外，LA在儿科患者中并不优于开腹阑尾切除术（OA）。年长儿童和体重>40 kg的儿童强烈支持使用LA。
研究区域内儿童阑尾切除术中LA的使用率与国际水平相似，但未随时间增加。爱尔兰外科医生在年幼儿童中仍倾向于OA，并更倾向于逐案处理而非将LA作为首选手术方式。尽管有区域和国际证据表明LA在儿童中具有良好的疗效，但情况依然如此。
