Allaway Matthew G R, Clement Kristenne, Eslick Guy D, Cox Michael R
Department of Surgery, Nepean Hosptial, P. O. Box 67, Penrith, NSW, 2751, Australia.
The Whiteley-Martin Research Centre, Clinical Sciences Building, Nepean Hospital, P. O. Box 67, Penrith, NSW, 2751, Australia.
World J Surg. 2019 Apr;43(4):998-1006. doi: 10.1007/s00268-018-4871-8.
Intra-abdominal abscess (IAA) complicates 2-3% of patients having an appendicectomy. The usual management is prolonged antibiotics and drainage of the IAA. From 2006, our unit chose to use early re-laparoscopy and washout in patients with persistent sepsis following appendicectomy. The aims of this study were to assess the outcomes of early laparoscopic washout in patients with features of persistent intra-abdominal sepsis and compare those with percutaneous drainage and open drainage of post-appendicectomy IAA.
A retrospective case note review was performed for all patients having a laparoscopic washout, percutaneous drainage or open drainage following appendicectomy between January 2006 and December 2017.
During the period, 4901 appendicectomies occurred. Forty-one (0.8%) patients had a laparoscopic washout, 16 (0.3%) had percutaneous drainage, and 6 (0.1%) had an open drainage. The demographics, ASA grade and pathology at initial appendicectomy were similar. The mean time after appendicectomy was significantly shorter for laparoscopic washout (4.1 days vs. 10.1 and 9.0 days, p = <0.003). The mean time for resolution of SIRS was significantly shorter (2.0 days vs. 3.3 and 5.2 days, p <0.02). The morbidity and length of stay were similar.
Early laparoscopic washout for persistent intra-abdominal sepsis may be an alternative to non-operative management and delayed intervention for IAA and may have better outcomes than either percutaneous drainage or open drainage. A prospective randomised comparison is required to further evaluate the indications and role of early laparoscopic washout post-appendicectomy.
腹腔内脓肿（IAA）是2%-3%阑尾切除术后患者的并发症。通常的治疗方法是延长抗生素使用时间并引流IAA。自2006年起，我们科室选择对阑尾切除术后持续脓毒症患者采用早期再次腹腔镜检查和冲洗。本研究的目的是评估早期腹腔镜冲洗治疗具有持续性腹腔内脓毒症特征患者的疗效，并将其与经皮引流和阑尾切除术后IAA的开放引流疗效进行比较。
对2006年1月至2017年12月期间所有接受阑尾切除术后进行腹腔镜冲洗、经皮引流或开放引流的患者进行回顾性病例记录审查。
在此期间，共进行了4901例阑尾切除术。41例（0.8%）患者接受了腹腔镜冲洗，16例（0.3%）接受了经皮引流，6例（0.1%）接受了开放引流。初次阑尾切除术时的人口统计学、美国麻醉医师协会（ASA）分级和病理情况相似。腹腔镜冲洗术后阑尾切除的平均时间明显更短（4.1天对10.1天和9.0天，p = <0.003）。全身炎症反应综合征（SIRS）消退的平均时间明显更短（2.0天对3.3天和5.2天，p <0.02）。发病率和住院时间相似。
对于持续性腹腔内脓毒症，早期腹腔镜冲洗可能是非手术治疗和IAA延迟干预的替代方法，并且可能比经皮引流或开放引流具有更好的疗效。需要进行前瞻性随机对照研究以进一步评估阑尾切除术后早期腹腔镜冲洗的适应证和作用。
