小儿阑尾周围脓肿保守治疗后腹腔镜阑尾切除最佳手术时机的探讨  

The optimal surgical time of laparoscopic appendicectomy after conservative treatment of appendiceal abscess in children

作　　者：彭飞 郑凯[1] 杨俊[1] 郭琴[1] 卞红强[1] Peng Fei;Zheng Kai;Yang Jun;Guo Qin;Bian Hongqiang(Department of General Surgery.One,Wuhan Children’s Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院普外一科,武汉430016

出　　处：《中华实用儿科临床杂志》2021年第23期1778-1781,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨小儿阑尾周围脓肿经保守治疗治愈后腹腔镜阑尾切除的最佳手术时机。方法回顾性分析2016年1月至2020年6月华中科技大学同济医学院附属武汉儿童医院普外科收治的86例诊断为阑尾周围脓肿患儿的临床资料,根据阑尾周围脓肿治愈后延期行腹腔镜阑尾切除手术时间间隔将86例患儿分为3组,A组:阑尾周围脓肿治愈4周后接受腹腔镜阑尾切除手术;B组:8周后接受腹腔镜阑尾切除手术;C组:12周及超过12周后接受腹腔镜阑尾切除手术。延期手术期间阑尾炎复发患儿不计入手术组。比较A、B、C 3组患儿延期手术期间阑尾炎复发发生率、术中并发症发生率、中转开腹发生率、手术时间、术后肠功能恢复时间、术后并发症发生率、术后住院时间等的差异。结果A组10例,行腹腔镜阑尾切除手术10例,阑尾炎复发0例;B组31例,行腹腔镜阑尾切除手术30例,阑尾炎复发1例;C组45例,行腹腔镜阑尾切除手术39例,阑尾炎复发6例。3组患儿在年龄、性别、阑尾周围脓肿直径、诊断阑尾周围脓肿时炎症指标、脓肿保守治疗治愈时间、行腹腔镜阑尾切除术时炎症指标差异均无统计学意义(均P>0.05)。在阑尾炎复发发生率方面,C组(13.33%)高于A组(0)与B组(3.22%),差异有统计学意义(P<0.05);而A组与B组差异无统计学意义(P>0.05)。在术中并发症发生率(A、B、C组分别为40.00%、10.00%、10.26%)、中转开腹发生率(A、B、C组分别为20.00%、0、0)、手术时间[A、B、C组分别为(106.70±7.42)d、(41.40±10.44)d、(39.60±11.27)d]、术后肠功能恢复时间[A、B、C组分别为(5.80±2.15)d、(0.93±0.17)d、(0.83±0.11)d]、术后并发症发生率(A、B、C组分别为40.00%、6.70%、5.10%)、术后住院时间[A、B、C组分别为(12.40±4.15)d、(1.67±0.31)d、(1.58±0.44)d]方面,A组均高于B组与C组,差异均有统计学意义(均P<0.05);B组与C组比较差异均无统计学意义(均P>0.05)。结�Objective To explore the optimal surgical time of laparoscopic appendectomy after conservative treatment of appendiceal abscess in children.Methods Clinical data of 86 children with appendiceal abscess diagnosed in the Department of General Surgery,Wuhan Children′s Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2016 to June 2020 were retrospectively analyzed.According to the delayed laparoscopic appendectomy interval after the appendiceal abscess was cured,86 children were divided into group A,B and C.Briefly,patients in the 3 groups were treated with laparoscopic appendectomy 4 weeks,8 weeks and over 12 weeks after the appendiceal abscess was cured,respectively.Children with recurrent appendicitis during delayed operation were not included.The incidence of appendicitis recurrence during delayed operation,the incidences of intraoperative complications,conversion to laparotomy,and postoperative complications,operation time,the time of postoperative intestinal function recovery,and postoperative hospital stay were compared among 3 groups.Results There were 10,31 and 45 cases in group A,B and C,respectively.Among them 10,30 and 39 patients received laparoscopic appendectomy,and 0,1 and 6 cases had appendicitis recurrence in group A,B and C,respectively.There were no significant differences in the age,gender,diameter of appendiceal abscess,inflammatory indexes at diagnosis of diagnosing appendiceal abscess,cure time of conservative treatment of abscess,and inflammatory indexes at laparoscopic appendectomy among the 3 groups(all P>0.05).The incidence of appendicitis recurrence in group C(13.33%)was significantly higher than that in group A(0)and group B(3.22%)(P<0.05).There was no significant difference in the incidence of appendicitis recurrence between group A and group B(P>0.05).The incidences of intraoperative(group A,B,C was 40.00%,10.00%,10.26%,respectively)and postoperative complications(group A,B,C was 40.00%,6.70%,5.10%,respectively),and conversion to laparotomy(g

关 键 词：阑尾周围脓肿 保守治疗 阑尾切除术 延期手术 手术时机 

分 类 号：R726.5[医药卫生—儿科]