Hosokawa Takahiro, Yamada Yoshitake, Tanami Yutaka, Sato Yumiko, Ishimaru Tetsuya, Kawashima Hiroshi, Oguma Eiji
Department of Radiology, Saitama Children's Medical Center, Japan.
Department of Radiology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
AJR Am J Roentgenol. 2019 Jul;213(1):191-199. doi: 10.2214/AJR.18.20937. Epub 2019 Apr 11.
The purpose of this study is to evaluate the association between sonographic findings and the operative time of transumbilical laparoscopic-assisted appendectomy (TULAA) for appendicitis in children. We included 131 children who underwent ultrasound within 24 hours before TULAA. We evaluated the associations between operative time and patients' demographics, as well as the following sonographic findings: maximum outer wall diameter of the appendix, appendicolith, ascites (not echogenic), echogenic ascites, abscess formation, increased intraabdominal fat echo in the right lower quadrant (RLQ; 3-point scale), and the location of the appendix (three locations). The results were analyzed using simple linear regression or the test and a multiple liner regression model. The mean (± SD) patient age was 9.50 ± 2.92 years (range, 3-15 years), and the mean operative time was 73.04 ± 36.56 minutes (range, 25-210 minutes). Univariate analysis showed that higher body mass index, greater maximum outer wall diameter of the appendix, higher grade of intraabdominal fat echo in the RLQ, presence of appendicolith, presence of echogenic ascites, abscess formation, and location of the appendix in the pelvis were associated with increased operative time. Multivariate analysis found that abscess formation and higher grade of increased intraabdominal fat echo in the RLQ were independently associated with operative time (both < 0.05). Preoperative sonographic findings of abscess formation and increased intraabdominal fat echo in the RLQ were factors independently associated with prolonged operative time for TULAA. On the basis of these sonographic findings, surgeons may predict additional surgical procedures, including abscess aspiration or adhesiolysis, and operative time before beginning the operation.
本研究的目的是评估超声检查结果与儿童阑尾炎经脐腹腔镜辅助阑尾切除术（TULAA）手术时间之间的关联。我们纳入了131例在TULAA术前24小时内接受超声检查的儿童。我们评估了手术时间与患者人口统计学特征之间的关联，以及以下超声检查结果：阑尾最大外壁直径、阑尾粪石、腹水（无回声）、有回声腹水、脓肿形成、右下腹（RLQ；3分制）腹腔内脂肪回声增加以及阑尾位置（三个位置）。使用简单线性回归或检验以及多元线性回归模型对结果进行分析。患者的平均（±标准差）年龄为9.50±2.92岁（范围3 - 15岁），平均手术时间为73.04±36.56分钟（范围25 - 210分钟）。单因素分析显示，较高的体重指数、阑尾较大的最大外壁直径、RLQ腹腔内脂肪回声较高等级、存在阑尾粪石、存在有回声腹水、脓肿形成以及阑尾位于盆腔与手术时间增加相关。多因素分析发现，脓肿形成和RLQ腹腔内脂肪回声增加较高等级与手术时间独立相关（均P<0.05）。术前超声检查发现脓肿形成和RLQ腹腔内脂肪回声增加是与TULAA手术时间延长独立相关的因素。基于这些超声检查结果，外科医生在开始手术前可以预测包括脓肿抽吸或粘连松解在内的额外手术操作以及手术时间。
