Hosokawa Takahiro, Tanami Yutaka, Sato Yumiko, Ishimaru Tetsuya, Kawashima Hiroshi, Oguma Eiji
Department of Radiology, Saitama Children's Medical Center, Saitama, Japan.
Department of Surgery, Saitama Children's Medical Center, Saitama, Japan.
Afr J Paediatr Surg. 2021 Apr-Jun;18(2):73-78. doi: 10.4103/ajps.AJPS_94_20.
The purpose was to evaluate the association between operative time and findings noted on computed tomography (CT) immediately before interval appendectomy.
Forty-two children who underwent CT before interval appendectomy were included. We evaluated the association between operative time and these image findings: (1) appendicolith, (2) increased intra-abdominal fat density around the appendix, (3) location of the appendix, (4) ascites, (5) abscess formation and (6) maximum appendix outer wall diameter. Appendix location was classified as (#1) just below the anterior abdominal wall; (#2) retrocaecal or retro-ascending colon and (#3) pelvic. Results were analysed using Pearson's correlation coefficient or Mann-Whitney U test.
The mean patient age and operative time were 116.24 ± 38.66 months (range, 31-195) and 67.76 ± 31.23 min (range, 30-179), respectively. Ascites was detected in only one case, and no abscess occurred in any patient; therefore, these findings were not analysed. Factors that significantly prolonged the operative time included increased intra-abdominal fat density around the appendix (absent, 59.43 ± 22.14 [range, 30-108] vs. present, 84.43 ± 40.13 [range, 32-179] min; P = 0.03) and retrocaecal or retro-ascending colon appendix (location 1, 40.83 ± 8.35 [range, 30-50]; location 2, 99.25 ± 18.56 [range, 74-135]; location 3, 64.54 ± 30.22 [range, 30-179] min; P < 0.01). There was a weak but significant association between maximum appendix outer wall diameter and operative time (R = 0.353; P = 0.02).
These pre-operative CT findings are important predictors of operative time for interval appendectomy. Radiologists and surgeons should use these specific image findings to predict the operative time and need for additional procedures during an interval appendectomy.
本研究旨在评估间隔期阑尾切除术之前的手术时间与计算机断层扫描（CT）检查结果之间的关联。
纳入42例在间隔期阑尾切除术前行CT检查的儿童。我们评估了手术时间与以下影像表现之间的关联：（1）阑尾粪石；（2）阑尾周围腹腔脂肪密度增加；（3）阑尾位置；（4）腹水；（5）脓肿形成；（6）阑尾最大外壁直径。阑尾位置分为：（1）紧邻前腹壁下方；（2）盲肠后或升结肠后；（3）盆腔。结果采用Pearson相关系数或Mann-Whitney U检验进行分析。
患者的平均年龄和手术时间分别为116.24±38.66个月（范围31 - 195个月）和67.76±31.23分钟（范围30 - 179分钟）。仅1例检测到腹水，所有患者均未发生脓肿，因此未对这些结果进行分析。显著延长手术时间的因素包括阑尾周围腹腔脂肪密度增加（无，59.43±22.14[范围30 - 108]分钟 vs. 有，84.43±40.13[范围32 - 179]分钟；P = 0.03）以及盲肠后或升结肠后阑尾（位置1，40.83±8.35[范围30 - 50]分钟；位置2，99.25±18.56[范围74 - 135]分钟；位置3，64.54±30.22[范围30 - 179]分钟；P < 0.01）。阑尾最大外壁直径与手术时间之间存在微弱但显著的关联（R = 0.353；P = 0.02）。
这些术前CT表现是间隔期阑尾切除术手术时间的重要预测指标。放射科医生和外科医生应利用这些特定的影像表现来预测间隔期阑尾切除术的手术时间以及是否需要额外的手术操作。
