Pederiva Federica, Bussani Rossana, Shafiei Vennus, Codrich Daniela, Guida Edoardo, Schleef Jurgen
Pediatric Surgery, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy.
Department of Pathology, Azienda Sanitaria Universitaria Integrata di Trieste, 34137 Trieste, Italy.
Children (Basel). 2021 Sep 16;8(9):811. doi: 10.3390/children8090811.
Whilst most surgeons agree that conservative treatment of appendiceal abscess in children is an adequate treatment, the need for subsequent interval appendectomy is still controversial. We analyzed the histopathology in interval appendectomy in search of signs of inflammation. All patients admitted between 2010 and 2017 with appendiceal abscess and scheduled for interval appendectomy were reviewed. The specimens were evaluated for grade of inflammation, type and distribution of cellular infiltrate, presence of necrosis or hemorrhage and infiltrate in the serosa. Forty-two patients had appendiceal abscess and were treated conservatively. Seven underwent emergent appendectomy. Thirty-three out of 35 patients underwent elective interval appendectomy. Thirty-two specimens were revised. Carcinoid tumor or other malignant lesions were not found. All of them presented some amount of inflammation, grade 1 to 2 in 53%, grade 3 to 4 in 47%. Twenty-five percent of the specimens had signs of necrosis accompanied by hemorrhage and in more than the half (53%) the infiltrate extended to the serosa. Conclusions: Although the appendix was mostly found not macroscopically inflamed intraoperatively, histology confirmed a certain grade of inflammation even months after the conservative treatment. No correlation was found between histopathologic findings and lapse of time between abscess treatment and interval appendectomy.
虽然大多数外科医生都认为，对儿童阑尾脓肿进行保守治疗是一种充分的治疗方法，但后续进行间隔期阑尾切除术的必要性仍存在争议。我们分析了间隔期阑尾切除术中的组织病理学情况，以寻找炎症迹象。回顾了2010年至2017年间所有因阑尾脓肿入院并计划进行间隔期阑尾切除术的患者。对标本进行了炎症分级、细胞浸润类型和分布、坏死或出血情况以及浆膜浸润情况的评估。42例患者患有阑尾脓肿并接受了保守治疗。7例接受了急诊阑尾切除术。35例患者中有33例接受了择期间隔期阑尾切除术。对32份标本进行了复查。未发现类癌肿瘤或其他恶性病变。所有标本均有一定程度的炎症，53%为1至2级，47%为3至4级。25%的标本有坏死伴出血迹象，超过半数（53%）的标本浸润延伸至浆膜。结论：尽管术中大多发现阑尾在宏观上无炎症，但组织学证实即使在保守治疗数月后仍有一定程度的炎症。在组织病理学结果与脓肿治疗至间隔期阑尾切除术之间的时间间隔上未发现相关性。
