Heise Joachim Wilfried, Kentrup Heiner, Dietrich Christoph Gerhart, Cosler Ansgar, Hübner Dolores, Krumholz Werner
Department of General, Visceral and Thyroid Surgery, Bethlehem Gesundheitszentrum Stolberg (Rhld.), Stolberg, Germany.
Department of Pediatrics, Bethlehem Gesundheitszentrum Stolberg (Rhld.), Stolberg, Germany.
Visc Med. 2021 Jun;37(3):180-188. doi: 10.1159/000510487. Epub 2020 Oct 5.
Since conservative antibiotic treatment in uncomplicated appendicitis might not solve the clinical problem definitively, it has to compete with the results of today's laparoscopic appendectomy.
In a county hospital, accommodating also a pediatric department, all cases of appendectomy for suspected appendicitis over 15 years were analyzed retrospectively for the following items: beginning of symptoms, time from admission to surgery, surgical technique as "open," "laparoscopic" or "converted," if perforated at operation and histological confirmation of acute inflammation. Surgical morbidity was detected in distinct categories. To evaluate changes over time, 3 time periods of 5 years each were defined.
Resulting in a total of 1,956 cases there were 731 in group I, 633 in group II and 592 in group III within the 3 time periods, respectively. The median age was 17 years. The percentage of perforations was 16.8%. Those patients had - with 47 compared to 27 h - a significantly prolonged time from the beginning of symptoms to admission ( = 0.0001). The proportion of laparoscopic surgery rose from 83.3 (group I) to 98.3% (group III; = 0.0001). The median postoperative hospital stay diminished from 4 to 3 days in nonperforated ( = 0.0001) and from 8 to 7 days in perforated cases ( = 0.0009). Surgical morbidity was reduced from 4.1% in the first to 1.7% in the third observation period ( = 0.0144). There were no surgical site infections during the last 5 years.
Timely laparoscopic appendectomy in case of suspected appendicitis can be offered with an extraordinary low morbidity. Taking into account the complete solution of the otherwise pending threat, compared to conservative antibiotic treatment, it is safe and definitive.
由于单纯性阑尾炎的保守抗生素治疗可能无法彻底解决临床问题，因此它必须与当今腹腔镜阑尾切除术的效果相竞争。
在一家设有儿科的县级医院，对所有15岁以上疑似阑尾炎行阑尾切除术的病例进行回顾性分析，分析以下项目：症状出现时间、入院至手术时间、手术方式（“开放”、“腹腔镜”或“中转”）、术中是否穿孔以及急性炎症的组织学证实。按不同类别检测手术并发症。为评估随时间的变化，定义了3个各为期5年的时间段。
在3个时间段内，共1956例病例，分别为第一组731例、第二组633例和第三组592例。中位年龄为17岁。穿孔率为16.8%。这些患者从症状出现到入院的时间明显延长（47小时对比27小时，P = 0.0001）。腹腔镜手术的比例从83.3%（第一组）升至98.3%（第三组，P = 0.0001）。非穿孔病例的术后中位住院时间从4天减至3天（P = 0.0001），穿孔病例从8天减至7天（P = 0.0009）。手术并发症从第一个观察期的4.1%降至第三个观察期的1.7%（P = 0.0144）。在过去5年中无手术部位感染。
对于疑似阑尾炎病例，及时进行腹腔镜阑尾切除术的发病率极低。与保守抗生素治疗相比，考虑到能彻底解决原本悬而未决的威胁，它既安全又有效。
