Pearl R H, Hale D A, Molloy M, Schutt D C, Jaques D P
Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr Surg. 1995 Feb;30(2):173-8; discussion 178-81. doi: 10.1016/0022-3468(95)90556-1.
To define patterns of care and outcome for pediatric appendectomy.
A study was designed to evaluate all pediatric appendectomies performed in the 147 Department of Defense hospitals worldwide. Cases of nonincidental appendectomy were identified through discharge diagnoses and operative logs, and 98.6% of the charts were retrieved for review. All charts were abstracted, and data were entered into a 127-field database for analysis.
Over a 12-month period, ending January 1993, appendectomy was performed on 1,366 pediatric patients in the Department of Defense hospital system. The patients' median age was 12 years (range, 6 months to 18 years); 59% were male. The diagnosis was normal appendix for 157 patients (12%), acute nonperforated appendicitis for 930 (68%), and perforated appendicitis for 279 (20%). Age < or = 8 years was predictive (P < .001) of a higher rate of perforated appendicitis (33% v 18%) but was not predictive of normal pathology (13% v 11%). Female gender was associated with a significantly higher rate of normal pathology (17% v 8%; P < .001) but not of perforation (18% v 22%). Temperature elevation and right lower quadrant pain and tenderness did not clinically distinguish between diagnostic groups. Sixty-two percent of patients with a normal appendix had a white blood cell count of more than 10,000/mm3, as did 91% of patients with acute or perforated appendicitis. Those with perforated appendicitis received pre- and postoperative antibiotics, primarily ampicillin/gentamicin/clindamycin or Flagyl (41%), cefoxitin (34%), or Unasyn (15%). In 77% of this subgroup, intraoperative cultures were positive, with isolates for Escherichia coli (76%) Enterococcus (30%), Bacteroides (24%), and Pseudomonas (20%) predominating. There were no deaths. Major complications occurred in 1.2% of patients with acute appendicitis and in 6.4% of those with perforated appendicitis; there were no major complications in the group with normal appendectomies. The hospitalization period was more than 7 days for 1.6%, 40%, and 3.8%, respectively.
This large series, from a large number of hospitals, with multiple practitioners, can serve as a community standard for pediatric appendectomy in the 1990s.
确定小儿阑尾切除术的治疗模式及结果。
本研究旨在评估全球147家国防部医院所施行的所有小儿阑尾切除术。通过出院诊断和手术记录确定非偶然阑尾切除术病例，并检索了98.6%的病历进行回顾。对所有病历进行摘要提取，并将数据录入一个包含127个字段的数据库进行分析。
在截至1993年1月的12个月期间，国防部医院系统为1366例小儿患者实施了阑尾切除术。患者的中位年龄为12岁（范围为6个月至18岁）；59%为男性。诊断为正常阑尾的有157例患者（12%），急性非穿孔性阑尾炎930例（68%），穿孔性阑尾炎279例（20%）。年龄≤8岁可预测（P<.001）穿孔性阑尾炎发生率较高（33%对18%），但不能预测病理正常情况（13%对11%）。女性病理正常的发生率显著较高（17%对8%；P<.001），但穿孔发生率无差异（18%对22%）。体温升高以及右下腹疼痛和压痛在各诊断组之间无临床鉴别意义。阑尾正常的患者中有62%白细胞计数超过10,000/mm³，急性或穿孔性阑尾炎患者中这一比例为91%。穿孔性阑尾炎患者术前和术后接受抗生素治疗，主要是氨苄西林/庆大霉素/克林霉素或甲硝唑（41%）、头孢西丁（34%）或优立新（15%）。在该亚组的77%患者中，术中培养呈阳性，主要分离菌为大肠埃希菌（76%）、肠球菌（30%）、拟杆菌（24%）和铜绿假单胞菌（20%）。无死亡病例。急性阑尾炎患者中1.2%发生严重并发症，穿孔性阑尾炎患者中6.4%发生严重并发症；正常阑尾切除术组无严重并发症。住院时间超过7天的患者分别为1.6%、40%和3.8%。
这个来自众多医院、由多名从业者参与的大型系列研究可作为20世纪90年代小儿阑尾切除术的社区标准。
