Department of Radiology, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, NY.
Department of Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, NY.
J Pediatr Surg. 2020 Mar;55(3):414-417. doi: 10.1016/j.jpedsurg.2019.09.005. Epub 2019 Oct 23.
To determine the optimal nonoperative management of periappendiceal abscess in a pediatric population, we compared the therapeutic efficacy and cost-effectiveness of antibiotics alone versus antibiotics plus percutaneous drainage (PD).
We conducted a 10-year retrospective chart review of pediatric patients less than 18 years of age who had acute perforated appendicitis complicated by periappendiceal abscess. Group 1 consisted of patients (N = 35) who received nonoperative management with antibiotics only. Group 2 consisted of patients (N = 11) who underwent PD and also received antibiotics. Group 1 was subdivided into groups 1A and 1B. Group 1A consisted of patients (N = 25) who responded to antibiotics treatment. Group 1B consisted of patients (N = 10) who were initially treated with antibiotics but subsequently required PD. Patients' demographics, initial clinical presentation, abscess size and location, length of hospital stay, outcome, and complications were compared among these groups.
Median hospital stay of group 1A and group 2 was identical at 6 days. Group 1B had a significantly longer median hospital stay of 13 days. There were no deaths and no significant long-term complications in any group. One patient in group 1A returned to the emergency room (ER) for abdominal pain and was readmitted for observation. Four patients in group 1B returned to the ER shortly after discharge and required readmission. One of these 4 patients developed acute pancreatitis in addition to enlarging abscess and underwent surgical drainage. There were no documented failures or complications of treatment in group 2 prior to interval appendectomy with the exception of 1 patient lost to follow-up. The presence of small bowel obstruction at the time of admission was an independent predictor of increased length of stay.
Antibiotic therapy alone can be effective in a majority of patients and is recommended as initial management. To prevent potential complications and increased cost, PD should not be delayed if clinical symptoms persist or the abscess remains unchanged. Reimaging 6 days after initiation of antibiotic therapy with ultrasound or MRI is recommended to identify patients who would progress on antibiotics alone or who need to receive drainage without delay.
Level III.
为了确定小儿阑尾周围脓肿的最佳非手术治疗方法，我们比较了单纯使用抗生素与抗生素联合经皮引流（PD）的治疗效果和成本效益。
我们对 10 年来小于 18 岁的急性穿孔性阑尾炎合并阑尾周围脓肿的患儿进行了回顾性病历分析。第 1 组（N=35）接受单纯抗生素非手术治疗，第 2 组（N=11）接受 PD 联合抗生素治疗。第 1 组进一步分为 1A 组和 1B 组。1A 组（N=25）对抗生素治疗有反应，1B 组（N=10）最初接受抗生素治疗，但随后需要 PD。比较这些组之间的患者人口统计学、初始临床表现、脓肿大小和位置、住院时间、结局和并发症。
1A 组和 2 组的中位住院时间相同，均为 6 天。1B 组的中位住院时间明显更长，为 13 天。所有组均无死亡和明显的长期并发症。1A 组中有 1 例患者因腹痛返回急诊室（ER）并再次入院观察。1B 组中有 4 例患者在出院后不久返回 ER 并再次入院。其中 1 例患者除脓肿增大外还发生急性胰腺炎，行手术引流。除 1 例患者失访外，2 组在间隔阑尾切除术前均无治疗失败或并发症。入院时存在小肠梗阻是住院时间延长的独立预测因素。
抗生素治疗在大多数患者中是有效的，推荐作为初始治疗。为了预防潜在的并发症和增加成本，如果临床症状持续存在或脓肿没有变化，不应延迟 PD。建议在开始抗生素治疗后 6 天用超声或 MRI 进行重新成像，以识别单独使用抗生素进展的患者或需要立即引流的患者。
III 级。
Zotero 插件