Bufo A J, Shah R S, Li M H, Cyr N A, Hollabaugh R S, Hixson S D, Schropp K P, Lasater O E, Joyner R E, Lobe T E
Section of Pediatric Surgery, University of Tennessee, Le Bonheur Children's Medical Center, Memphis 38105, USA.
J Laparoendosc Adv Surg Tech A. 1998 Aug;8(4):209-14. doi: 10.1089/lap.1998.8.209.
To determine the efficacy, safety, and cost of managing perforated appendicitis with intravenous antibiotics followed by an interval appendectomy, the charts of 87 children with ruptured appendicitis were retrospectively reviewed. These patients were treated with intravenous fluid resuscitation and antibiotics (consisting of clindamycin and ceftazidime) and underwent appendectomy, either on that admission (n = 46) or as a delayed interval procedure (n = 41). Antibiotics in all cases were discontinued either at home or in the hospital after the child was a febrile for 48 hours with normal white and differential blood cell counts, and the two groups were compared. Seven patients (17%) "failed" the interval appendectomy protocol. All but one "failure" was due to the development or persistence for >72 hours of a bowel obstruction. The data are described below as percent or mean +/- 1 standard deviation. [table: see text] We conclude that antibiotics and interval appendectomy is a safe effective alternative for the management of perforated appendicitis. When successful, hospitalization, charges, and morbidity are less with this approach. A persistent bowel obstruction for 72 hours is an indication to proceed with appendectomy on admission.
为确定静脉使用抗生素后行间隔期阑尾切除术治疗穿孔性阑尾炎的疗效、安全性和成本，我们回顾性分析了87例阑尾破裂患儿的病历。这些患者接受了静脉液体复苏和抗生素治疗（包括克林霉素和头孢他啶），并接受了阑尾切除术，其中46例在此次入院时进行，41例作为延迟间隔期手术。所有病例在患儿发热48小时且白细胞及分类计数正常后，于家中或医院停用抗生素，并对两组进行比较。7例患者（17%）“未通过”间隔期阑尾切除术方案。除1例“未成功”外，其余均因肠梗阻发生或持续超过72小时。数据以百分比或均值±1标准差表示。[表格：见原文]我们得出结论，抗生素和间隔期阑尾切除术是治疗穿孔性阑尾炎的一种安全有效的替代方法。成功实施该方法时，住院时间、费用和发病率均较低。肠梗阻持续72小时是入院时行阑尾切除术的指征。
