经脐腹腔镜辅助小儿急性阑尾炎切除术：阑尾残端内翻并非必要——一项回顾性研究

Transumbilical laparoscopic-assisted appendectomy for acute appendicitis in children: appendiceal stump inversion is not necessary-a retrospective study.

作者信息

Mazzarolo Stella, Boscarelli Alessandro, Giangreco Manuela, Dobrinja Chiara, Codrich Daniela, Scarpa Maria-Grazia, Iaquinto Marianna, Peric-Anicic Matea, Olenik Damiana, Maita Sonia, Guida Edoardo, Schleef Jürgen

机构信息

Faculty of Medicine and Surgery, University of Trieste, Trieste, Italy.

Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria, 65/1, 34137, Trieste, Italy.

出版信息

Pediatr Surg Int. 2025 Jun 26;41(1):194. doi: 10.1007/s00383-025-06103-w.

DOI:10.1007/s00383-025-06103-w

PMID:40569465

Abstract

PURPOSE

Acute appendicitis is one of the most common surgical conditions in pediatric and general surgery. The purpose of this study was to retrospectively investigate the management strategies of the appendiceal stump during transumbilical laparoscopic-assisted appendectomy for acute appendicitis in terms of surgical time, hospital length of stay, and postoperative complications.

METHODS

The records of patients < 18 years of age who were treated for acute appendicitis at our Pediatric Surgery Unit from December 2018 to January 2024 were retrospectively reviewed. Data were extrapolated from the departmental database, and clinical notes were reviewed.

RESULTS

The records of 278 patients who underwent appendectomy within a 5-year period at our institution were essentially used to compare appendiceal stump inversion and simple ligation. Appendiceal stump invagination was performed in 208 patients (74.8%), comprising 106 females (51.0%) and 102 males (49.0%), with a median age of 11 years (IQR 8-15) and a median weight of 36.5 kg (IQR 28-54). Twenty-six (12.5%) patients had associated conditions. The appendiceal stump was not invaginated in 70 children (25.2%), consisting of 26 females (37.1%) and 44 males (62.9%), with a median age of 11 years (IQR 8-14) and a median weight of 38.3 kg (IQR 29.5-47). Fourteen patients (20%) had associated pathologies. The two groups were similar in terms of sex (P = 0.05), age (P = 0.40), weight (P = 0.78), and associated pathologies (P = 0.12). Notably, 78.6% of appendicitis cases treated without stump invagination were uncomplicated, whereas 20% were complicated (4.3% abscess and 15.7% peritonitis cases). In contrast, stump invagination was performed in 87% of uncomplicated appendicitis and 13.1% of complicated appendicitis cases (6.8% abscess and 6.3% peritonitis cases). Therefore, simple ligation was also effective in complicated appendicitis cases (P = 0.03). In addition, the median surgical duration was 63.5 min (IQR 46-90) for patients undergoing stump inversion and 69 min (IQR 60-115) for patients undergoing simple ligation respectively (P = 0.02). Interestingly, statistical analysis revealed no significant differences in length of hospital stay (P = 0.21) and postoperative complications (P = 0.15).

CONCLUSION

Simple ligation does not compromise treatment efficacy nor increase postoperative complications, nor the length of hospital stay.

摘要

目的

急性阑尾炎是小儿外科和普通外科最常见的手术疾病之一。本研究的目的是回顾性研究经脐腹腔镜辅助阑尾切除术治疗急性阑尾炎时阑尾残端的处理策略，包括手术时间、住院时间和术后并发症。

方法

回顾性分析2018年12月至2024年1月在我院小儿外科接受急性阑尾炎治疗的18岁以下患者的病历。数据从科室数据库中提取，并查阅临床记录。

结果

本机构5年内接受阑尾切除术的278例患者的记录主要用于比较阑尾残端内翻和单纯结扎。208例患者（74.8%）进行了阑尾残端内翻，其中女性106例（51.0%），男性102例（49.0%），中位年龄11岁（四分位间距8 - 15岁），中位体重36.5 kg（四分位间距28 - 54 kg）。26例（12.5%）患者有合并症。70例儿童（25.2%）未进行阑尾残端内翻，其中女性26例（37.1%），男性44例（62.9%），中位年龄11岁（四分位间距8 - 14岁），中位体重38.3 kg（四分位间距29.5 - 47 kg）。14例患者（20%）有相关病变。两组在性别（P = 0.05）、年龄（P = 0.40）、体重（P = 0.78）和合并病变（P = 0.12）方面相似。值得注意的是，未进行残端内翻治疗的阑尾炎病例中，78.6%为非复杂性病例，而20%为复杂性病例（4.3%为脓肿病例，15.7%为腹膜炎病例）。相比之下，87%的非复杂性阑尾炎病例和13.1%的复杂性阑尾炎病例（6.8%为脓肿病例，6.3%为腹膜炎病例）进行了残端内翻。因此，单纯结扎在复杂性阑尾炎病例中也有效（P = 0.03）。此外，进行残端内翻的患者中位手术时间为63.5分钟（四分位间距46 - 90分钟），进行单纯结扎的患者中位手术时间为69分钟（四分位间距60 - 115分钟）（P = 0.02）。有趣的是，统计分析显示住院时间（P = 0.21）和术后并发症（P = 0.15）无显著差异。