Samelson S L, Reyes H M
Arch Surg. 1987 Jun;122(6):691-6. doi: 10.1001/archsurg.1987.01400180073014.
Of 522 children with acute appendicitis treated from 1978 to 1985, 170 had appendiceal perforation with peritonitis. The protocol for perforation included aggressive fluid resuscitation, preoperative triple antibiotic therapy, copious peritoneal lavage, avoidance of transperitoneal drains except those used for well-localized abscesses, delayed wound closure, and postoperative antibiotic therapy for seven to ten days. The minor complication rate was 22%; this included pleural effusion, wound infection, atelectasis, and prolonged ileus. The major complication rate was 3%; this included intra-abdominal abscess, gastrointestinal bleeding, wound dehiscence, pneumonia, and intestinal obstruction. Only four postoperative intra-abdominal abscesses occurred, in three patients. The mortality rate was zero. A comparison of this series with a similar group of 24 patients who underwent drainage showed the relative rate of abdominal abscess formation to be 1.8% (undrained) vs 12.5% (drained). We achieved our lowest rate of serious complications following surgery for pediatric perforated appendix with the use of aggressive fluid resuscitation, broad-spectrum antibiotic therapy, copious peritoneal irrigation, and delayed wound closure and without drainage.
在1978年至1985年接受治疗的522例急性阑尾炎患儿中，170例发生阑尾穿孔并伴有腹膜炎。针对穿孔的治疗方案包括积极的液体复苏、术前三联抗生素治疗、大量腹腔灌洗、除用于定位明确的脓肿外避免放置经腹引流管、延迟伤口缝合以及术后7至10天的抗生素治疗。 minor并发症发生率为22%；包括胸腔积液、伤口感染、肺不张和肠梗阻持续时间延长。major并发症发生率为3%；包括腹腔内脓肿、胃肠道出血、伤口裂开、肺炎和肠梗阻。仅3例患者出现4例术后腹腔内脓肿。死亡率为零。将该系列与另一组24例接受引流的类似患者进行比较，腹腔脓肿形成的相对发生率为1.8%（未引流）对12.5%（引流）。通过积极的液体复苏、广谱抗生素治疗、大量腹腔灌洗、延迟伤口缝合且不进行引流，我们在小儿穿孔性阑尾炎手术后实现了最低的严重并发症发生率。
