Toki A, Ogura K, Horimi T, Tokuoka H, Todani T, Watanabe Y, Uemura S, Urushihara N, Noda T, Sato Y
Department of Pediatric Surgery, Kochi Municipal Central Hospital, Japan.
Surg Today. 1995;25(3):207-10. doi: 10.1007/BF00311528.
A total of 231 children with acute appendicitis were treated at our hospitals during the 10 years between 1984 and 1993, 53 of whom had a perforated appendix. These 53 patients were randomly assigned to two groups at the time of surgery according to the different procedures performed. Thus, 29 children were managed by appendectomy followed by peritoneal lavage using a large amount of saline, and intravenous antibiotic therapy consisting of aminoglycoside and cephem (lavage group), while the other 24 children were treated by appendectomy with silicon tube drainage and the same systemic antibiotic therapy (drainage group). The mean length of hospitalization, and the mean durations of fever and the need for fasting after laparotomy in the lavage group were significantly less than those in the drainage group: 10.1 versus 18.8 days, 2.8 versus 7.7 days, and 1.8 versus 3.5 days, respectively. The operation wounds healed well in the lavage group due to the fact that there was no drain. Wound infections occurred in two children from the lavage group and six from the drainage group. Intra-abdominal abscesses occurred in two children from the drainage group. Accordingly, peritoneal lavage appears to be superior to intraperitoneal tube drainage for the management of perforated appendicitis in children.
1984年至1993年的10年间，我院共收治231例急性阑尾炎患儿，其中53例阑尾穿孔。这53例患者在手术时根据所采用的不同手术方式随机分为两组。因此，29例患儿行阑尾切除术后用大量生理盐水进行腹腔灌洗，并给予由氨基糖苷类和头孢菌素组成的静脉抗生素治疗（灌洗组），而另外24例患儿行阑尾切除术后用硅胶管引流并给予相同的全身抗生素治疗（引流组）。灌洗组的平均住院时间、平均发热持续时间以及剖腹术后禁食时间均显著短于引流组，分别为10.1天对18.8天、2.8天对7.7天、1.8天对3.5天。由于没有放置引流管，灌洗组的手术切口愈合良好。灌洗组有2例患儿发生伤口感染，引流组有6例。引流组有2例患儿发生腹腔脓肿。因此，对于儿童穿孔性阑尾炎的治疗，腹腔灌洗似乎优于腹腔置管引流。
