Elmore J R, Dibbins A W, Curci M R
Arch Surg. 1987 Apr;122(4):424-7. doi: 10.1001/archsurg.1987.01400160050006.
From 1976 to 1985, 233 consecutive children were treated for appendicitis by a standardized protocol. Forty-nine percent of these cases were complicated: 11% by gangrene, 33% by perforation, and 4% by perforations with well-developed abscesses. Treatment of gangrenous and perforated appendicitis consisted of administration of ampicillin sodium, gentamicin sulfate, and clindamycin phosphate; appendectomy; and saline peritoneal irrigation. Transperitoneal drainage was not used. Skin and subcutaneous tissues were left open for delayed primary wound closure. Perforations with well-developed abscesses were treated with triple antibiotic therapy and interval appendectomy. The only infectious complication was one intra-abdominal abscess. There were no wound infections or deaths. The rate of infectious complications was 0.9%, and the overall morbidity was 4.4%. This standardized treatment of complicated appendicitis in children prevents wound infection and significantly decreases the incidence of intra-abdominal abscess formation and mortality.
1976年至1985年期间，233名连续的儿童按照标准化方案接受阑尾炎治疗。其中49%的病例为复杂性阑尾炎：11%为坏疽性，33%为穿孔性，4%为伴有成熟脓肿的穿孔性。坏疽性和穿孔性阑尾炎的治疗包括给予氨苄西林钠、硫酸庆大霉素和磷酸克林霉素；阑尾切除术；以及生理盐水腹腔灌洗。未采用经腹引流。皮肤和皮下组织敞开，以便延迟一期伤口缝合。伴有成熟脓肿的穿孔性阑尾炎采用三联抗生素治疗和间隔期阑尾切除术。唯一的感染性并发症是1例腹腔内脓肿。无伤口感染或死亡病例。感染性并发症发生率为0.9%，总体发病率为4.4%。这种针对儿童复杂性阑尾炎的标准化治疗可预防伤口感染，并显著降低腹腔内脓肿形成的发生率和死亡率。
