Fitzgerald Caitlin A, Kernell Caroline, Mejia-Martinez Valeria, Peng Giselle, Zakaria Heba, Zhu Michelle, Butler Dale, Bruns Brandon
Department of Surgery, Division of Trauma and Acute Care Surgery, East Carolina University, Greenville, NC, USA.
University of Texas Southwestern Medical School, Dallas, TX, USA.
Surg Open Sci. 2024 Jul 22;20:242-246. doi: 10.1016/j.sopen.2024.07.008. eCollection 2024 Aug.
The optimal management of perforated appendicitis remains controversial. Many studies advocate for antibiotics and an interval appendectomy whereas others suggest that performing an appendectomy at the time of presentation decreases post-operative morbidity. Confounding this argument further are the patients who fail non-operative management and end up requiring surgery during their initial hospitalization. This study aims to determine if early operative intervention should be considered for perforated appendicitis.
This was a retrospective review of all patients who underwent an appendectomy (both laparoscopic or open) for perforated appendicitis between 2015 and 2020 at our institution.
A total of 271 patients met inclusion criteria for this study. Of this group, 250 patients underwent an immediate appendectomy whereas the remaining 21 patients underwent a trial of non-operative management and eventually required an appendectomy during their initial admission. When comparing the immediate versus delayed operative groups, there were no differences in demographic data including age and gender, and no differences in various imaging findings including AAST Grade IV or V appendicitis. Operatively, patients in the delayed group had a longer operative time (83.1 ± 32.9 vs. 64.1 ± 26.2, = 0.01), were more likely to require an open operation (23.8 % vs. 2.8 %, < 0.0001), and were more likely to have a drain placed intra-operatively (42.9 % vs 14.4 %, = 0.004). While there were no differences in 30-day readmission rates, patients in the delayed group had a significantly longer hospital length of stay than patients in the immediate group (9.4 ± 7.4 vs. 3.1 ± 3.3, = 0.008).
Patients undergoing an immediate appendectomy for perforated appendicitis can discharge from the hospital sooner and demonstrate no increase in post-operative morbidity suggesting that surgeons can initially manage this disease process in an operative fashion.
穿孔性阑尾炎的最佳治疗方案仍存在争议。许多研究主张使用抗生素并进行间隔期阑尾切除术，而其他研究则表明，在就诊时进行阑尾切除术可降低术后发病率。使这一争论更加复杂的是那些非手术治疗失败并最终在初次住院期间需要手术的患者。本研究旨在确定穿孔性阑尾炎是否应考虑早期手术干预。
这是一项对2015年至2020年期间在本机构因穿孔性阑尾炎接受阑尾切除术（包括腹腔镜或开放手术）的所有患者的回顾性研究。
共有271例患者符合本研究的纳入标准。在该组中，250例患者接受了即刻阑尾切除术，而其余21例患者接受了非手术治疗试验，最终在初次住院期间需要进行阑尾切除术。比较即刻手术组和延迟手术组时，包括年龄和性别在内的人口统计学数据没有差异，包括美国创伤外科学会（AAST）IV级或V级阑尾炎在内的各种影像学检查结果也没有差异。在手术方面，延迟组患者的手术时间更长（83.1±32.9对64.1±26.2，P = 0.01），更有可能需要进行开放手术（23.8%对2.8%，P < 0.0001），并且更有可能在术中放置引流管（42.9%对14.4%，P = 0.004）。虽然30天再入院率没有差异，但延迟组患者的住院时间明显长于即刻组患者（9.4±7.4对3.1±3.3，P = 0.008）。
因穿孔性阑尾炎接受即刻阑尾切除术的患者可以更快出院，且术后发病率没有增加，这表明外科医生最初可以以手术方式处理这一疾病过程。
