Ein S H, Shandling B
Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr Surg. 1996 Jun;31(6):849-50. doi: 10.1016/s0022-3468(96)90151-7.
Since 1980, the authors have not routinely removed an appendix on an interval basis after treatment of a ruptured appendiceal mass (phlegmon and/or abscess). In the present group of patients, there were eight boys and two girls, two to 15 years of age (mean, 8.5 years). All presented with symptoms and signs typical of ruptured appendix, with a mass suspected by history and examination, and proven by radiological means (usually ultrasonography). The patients were treated for at least 1 week with intravenous triple antibiotics; three required drainage of their abscess (2 radiological, 1 surgical). The follow-up has been both clinical and sonographic. In all cases the inflammation disappeared with 1 month. One child (2 years old) returned in 2 months with symptoms and signs of a ruptured appendix, and appendectomy was performed. The other nine have remained well, for 6 months to 13 years. From this experience and a review of the literature, only a relatively small number of patients with a properly treated ruptured appendiceal mass (phlegmon and/or abscess) will return with a flareup (recurrence) of appendicitis (requiring appendectomy); the rest live a normal life, with their asymptomatic appendix intact.
自1980年以来，作者在治疗阑尾穿孔性肿块（蜂窝织炎和/或脓肿）后，未定期进行间隔性阑尾切除术。在本组患者中，有8名男孩和2名女孩，年龄在2至15岁之间（平均8.5岁）。所有患者均表现出典型的阑尾穿孔症状和体征，根据病史和检查怀疑有肿块，并通过影像学手段（通常为超声检查）得以证实。患者接受了至少1周的静脉三联抗生素治疗；3例患者的脓肿需要引流（2例通过影像学引导，1例通过手术）。随访采用临床检查和超声检查相结合的方式。所有病例的炎症在1个月内均消失。1名2岁儿童在2个月后因阑尾穿孔的症状和体征复诊，接受了阑尾切除术。其他9名患者情况良好，随访时间为6个月至13年。根据这一经验以及对文献的回顾，只有相对少数经过妥善治疗的阑尾穿孔性肿块（蜂窝织炎和/或脓肿）患者会因阑尾炎复发（需要进行阑尾切除术）而复诊；其余患者阑尾无症状，生活正常。
