Blanco Verdú M D, Peláez Mata D J, Gómez Sánchez A, Costa I Roig A, Carazo Palacios E, Proaño S, Diéguez Hernández-Vaquero I, Ordóñez Pereira J, Fanjul Gómez M, Morante Valverde R, Cano Novillo I, Vila Carbó J J, de Agustín Asencio J C
Gregorio Marañón General University Hospital. Madrid (Spain).
12 de Octubre University Hospital. Madrid (Spain).
Cir Pediatr. 2022 Apr 1;35(2):70-74. doi: 10.54847/cp.2022.02.14.
Acute appendicitis is the most frequent cause of acute abdomen in children. The objective of this study was to analyze the causes, approach, and results of complications requiring surgery following appendectomy.
A retrospective study of the appendectomies conducted in three third-level institutions from 2015 to 2019 was carried out. Complications, causes, and number of re-interventions, time from one surgery to another, surgical technique used, operative findings at baseline appendectomy according to the American Association for the Surgery of Trauma (AAST) classification, and hospital stay were collected.
3,698 appendicitis cases underwent surgery, 76.7% of which laparoscopically, with 37.2% being advanced (grades II-V of the AAST classification). Mean operating time was 50.4 minutes (49.8 ± 20.1 for laparoscopy vs. 49.9 ± 20.1 for open surgery, p > 0.05), and longer in patients requiring re-intervention (68.6 ± 27.2 vs. 49.1 ± 19.3, p < 0.001). 76 re-interventions (2.05%) were carried out. The causes included postoperative infection (n = 46), intestinal obstruction (n = 20), dehiscence (n = 4), and others (n = 6). Re-intervention risk was not impacted by the baseline approach used (open surgery or laparoscopy, OR: 1.044, 95% CI: 0.57-1.9), but it was by appendicitis progression (7.8% advanced vs. 0.7% incipient, OR: 12.52, 95% CI: 6.18-25.3). There was a tendency to use the same approach both at baseline appendectomy and re-intervention. This occurred in 72.2% of laparoscopic appendectomies, and in 67.7% of open appendectomies. The minimally invasive approach (50/76) was more frequent than the open one (27 laparoscopies and 23 ultrasound-guided drainages vs. 26 open surgeries) (p < 0.05). 55% of obstruction patients underwent re-intervention through open surgery (p > 0.05).
Re-intervention rate was higher in advanced appendicitis cases. In this series, the minimally invasive approach (laparoscopic or ultrasound-guided drainage) was the technique of choice for re-interventions.
急性阑尾炎是儿童急腹症最常见的病因。本研究的目的是分析阑尾切除术后需要手术治疗的并发症的原因、治疗方法及结果。
对2015年至2019年在三家三级医疗机构进行的阑尾切除术进行回顾性研究。收集并发症、病因、再次手术的次数、两次手术之间的时间、所采用的手术技术、根据美国创伤外科学会（AAST）分类在初次阑尾切除术中的手术发现以及住院时间。
3698例阑尾炎患者接受了手术，其中76.7%为腹腔镜手术，37.2%为进展期（AAST分类的II - V级）。平均手术时间为50.4分钟（腹腔镜手术为49.8±20.1分钟，开放手术为49.9±20.1分钟，p>0.05），需要再次手术的患者手术时间更长（68.6±27.2分钟对49.1±19.3分钟，p<0.001）。进行了76次再次手术（2.05%）。病因包括术后感染（n = 46）、肠梗阻（n = 20）、切口裂开（n = 4）和其他（n = 6）。再次手术的风险不受初次手术方式（开放手术或腹腔镜手术）的影响（OR：1.044，95%CI：0.57 - 1.9），但受阑尾炎进展情况的影响（进展期为7.8%，初期为0.7%，OR：12.52，95%CI：6.18 - 25.3）。在初次阑尾切除术和再次手术时倾向于采用相同的手术方式。在72.2%的腹腔镜阑尾切除术中以及67.7%的开放阑尾切除术中是这样。微创方法（50/76）比开放方法更常见（27例腹腔镜手术和23例超声引导下引流术对26例开放手术）（p<0.05）。55%的肠梗阻患者通过开放手术进行再次手术（p>0.05）。
进展期阑尾炎病例的再次手术率更高。在本系列研究中，微创方法（腹腔镜或超声引导下引流）是再次手术的首选技术。
