Stringel G
Division of Pediatric Surgery, University of Texas Health Science Center, Southwestern Medical School, Dallas.
Am J Surg. 1987 Dec;154(6):631-5. doi: 10.1016/0002-9610(87)90231-5.
Four hundred fourteen appendectomies in children have been described. Acute nonperforated appendicitis was seen in 57.1 percent of the patients and perforated appendicitis in 18.6 percent. A histologically normal appendix was seen in 14.3 percent of the patients. In 31 of these patients, other pathologic abnormalities were found to account for the symptoms, thus the number of negative explorations was reduced to 7 percent. The average length of hospitalization was 5.3 days for patients with acute nonperforated appendicitis and 7.3 days for patients with perforated appendicitis. A protocol was followed which consisted of fluid resuscitation, preoperative and postoperative administration of antibiotics, and surgical exploration with appendectomy in all patients. No interval appendectomies were performed. The peritoneal cavity was not irrigated and the use of drains was avoided as much as possible. All wounds were closed primarily without wound drains. Topical cefamandole powder was used in all cases. Aerobic and anaerobic culture specimens were obtained in all cases from the peritoneal cavity and appendiceal stump. Twenty-eight different organisms were recovered, B. fragilis being the most common followed by E. coli. Excellent results were obtained without mortality and a less than 1 percent complication rate. There was a shorter period of hospitalization for patients with perforated appendicitis and a shorter period of antibiotic treatment.
已描述了414例儿童阑尾切除术。57.1%的患者为急性非穿孔性阑尾炎，18.6%为穿孔性阑尾炎。14.3%的患者阑尾组织学正常。在这些患者中的31例，发现其他病理异常可解释症状，因此阴性探查的数量降至7%。急性非穿孔性阑尾炎患者的平均住院时间为5.3天，穿孔性阑尾炎患者为7.3天。遵循的方案包括液体复苏、术前和术后使用抗生素以及对所有患者进行手术探查并切除阑尾。未进行间隔期阑尾切除术。尽量避免冲洗腹腔并尽可能不使用引流管。所有伤口均一期缝合，不放置伤口引流管。所有病例均使用头孢孟多粉。所有病例均从腹腔和阑尾残端获取需氧和厌氧培养标本。共分离出28种不同的微生物，脆弱拟杆菌最常见，其次是大肠杆菌。取得了优异的结果，无死亡病例，并发症发生率低于1%。穿孔性阑尾炎患者的住院时间较短，抗生素治疗时间也较短。
