Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Section of Pediatric Surgery, Uppsala University Children's Hospital, Uppsala, Sweden.
J Pediatr Surg. 2020 Nov;55(11):2419-2424. doi: 10.1016/j.jpedsurg.2020.02.024. Epub 2020 Mar 2.
The aims of this study were to compare the incidence of small bowel obstruction (SBO) requiring laparotomy after laparoscopic appendectomy (LA) and open appendectomy (OA) in children and to identify risk factors for SBO.
Medical records of patients who underwent appendectomy from 2000 to 2014 at our department of Pediatric Surgery were reviewed. Risk factors were analyzed using Cox proportional hazard regression.
Totally 619 out of 840 patients were included. OA was performed in 474 (76.6%), LA in 130 patients (21%), and 15 (2.4%) were converted from LA to OA. Age, sex and proportion of perforated appendicitis were comparable in the LA and OA groups. Median follow-up time was 11.4 years (2.6-18.4). The incidence of SBO after LA was 1.5%, after OA 1.9% and in the converted group 6.7% (p = 0.3650). There were no significant differences in the incidence of postoperative intraabdominal abscess, wound infection or length of stay between LA and OA. Perforation and postoperative intra-abdominal abscess were identified as risk factors with 9.03 (p < 0.001) and 6.98 (p = 0.004) times higher risk of SBO, respectively.
The risk for SBO after appendectomy in children was significantly related to perforated appendicitis and postoperative intra-abdominal abscess and not to the surgical approach.
Level III.
本研究旨在比较腹腔镜阑尾切除术（LA）和开腹阑尾切除术（OA）后小儿小肠梗阻（SBO）需要剖腹手术的发生率，并确定 SBO 的危险因素。
回顾了 2000 年至 2014 年期间在我院小儿外科行阑尾切除术的患者的病历。使用 Cox 比例风险回归分析危险因素。
共纳入 840 例患者中的 619 例。474 例（76.6%）行 OA，130 例（21%）行 LA，15 例（2.4%）由 LA 转为 OA。LA 和 OA 组的年龄、性别和穿孔性阑尾炎比例无差异。中位随访时间为 11.4 年（2.6-18.4）。LA 后 SBO 的发生率为 1.5%，OA 后为 1.9%，转化组为 6.7%（p=0.3650）。LA 和 OA 之间术后腹腔脓肿、伤口感染或住院时间无显著差异。穿孔和术后腹腔脓肿是 SBO 的危险因素，风险分别为 9.03（p<0.001）和 6.98（p=0.004）倍。
小儿阑尾切除术后 SBO 的风险与穿孔性阑尾炎和术后腹腔脓肿显著相关，与手术方式无关。
III 级。
