小儿阑尾周围脓肿保守治疗后择期腹腔镜阑尾切除：附22例报告-《中国微创外科杂志》

文章信息/Info

Title:: Conservative Treatment of Pediatric Periappendiceal Abscess Followed by Selective Laparoscopic Appendectomy: Report of 22 Cases

作者:: 刘雪来** 陈震黄凯坤郑乐; (首都儿科研究所附属儿童医院普通外科，北京100020)

Author(s):: Liu Xuelai; Chen Zhen; Huang Kaikun; et al.; Department of General Surgery, Capital Institute of Pediatrics Affiliated Children Hospital, Beijing 100020, China

关键词:: 阑尾周围脓肿; 腹腔镜手术; 择期阑尾切除术; 小儿

Keywords:: Periappendiceal abscess; Laparoscopy; Selective appendectomy; Children

文献标志码:: B

摘要:: 目的总结小儿急性阑尾炎并发阑尾周围脓肿接受保守治疗后再次入院行择期腹腔镜阑尾切除术的操作体会。方法2019年9月~2024年7月，对22例急性阑尾炎并发阑尾周围脓肿接受保守治疗6~14周后患儿实施三孔法腹腔镜阑尾切除术。年龄5~14岁，平均8.5岁。经脐正中切口置入5 mm trocar和30°观察镜，经下腹壁正中膀胱上、左侧腹直肌外缘和脐下3~5 cm平面交界处分别置入5 mm trocar和操作钳。术中充分松解粘连，包括松解大网膜与盆腔侧壁粘连、回盲部与大网膜粘连、阑尾外侧与侧腹膜粘连、回肠末端与阑尾系膜组织粘连，显露病变阑尾，分别结扎和离断阑尾系膜和阑尾根部。结果22例均获成功。手术时间50~150 min，(75.5±10.0)min。术后6~8 h自行下床活动，术后1~1.5 d恢复排气并进流食。术后住院3~6 d，平均4 d。术后病理回报均为慢性阑尾炎伴坏疽穿孔。随访2~13个月，平均6个月，无腹痛、发热，均无切口感染、粘连性肠梗阻、阑尾残株炎和盆腔脓肿等并发症。结论小儿急性阑尾炎并发阑尾周围脓肿接受保守治疗后，择期腹腔镜阑尾切除术中松解腹腔和盆腔内的粘连是操作的关键，也是手术时间相对长的主要原因。粘连主要位于大网膜与盆腔侧壁之间，回盲部与大网膜、阑尾与侧腹膜和回肠末端肠系膜之间。充分松解粘连后行阑尾切除可有效解除腹痛等症状。

Abstract:: ObjectiveTo summarize the experience of performing selective laparoscopic appendectomy in readmission children who had been given conservative treatment for acute appendicitis complicated with periappendiceal abscess.MethodsFrom September 2019 to July 2024, 22 patients with acute appendicitis complicated with periappendiceal abscess underwent three port laparoscopic appendectomy after receiving conservative treatment for 6-14 weeks. Their age ranged 5-14 years old, with an average of 8.5 years old. A 5 mm trocar and a 30° laparoscope were inserted through a midline umbilical incision, and 5 mm trocars and forceps were placed at the suprapubic area, lateral to the left rectus abdominis, and 3-5 cm below the umbilicus. Adequate adhesiolysis was performed, including detaching the omentum from the pelvic sidewall, separating the ileocecal region from the omentum, and freeing the appendix from the lateral peritoneum and the mesenteric tissue of the terminal ileum to expose the affected appendix. The mesoappendix and the base of the appendix were then ligated and transected.ResultsThe operations in all the 22 cases were successful. The surgical time ranged 50-150 min (mean, 75.5±10.0 min). The patients were able to mobilize independently at 6-8 h postoperatively, resumed passing gas and consumed clear liquids within 1-1.5 d. The postoperative hospital stay was 3-6 d, with an average of 4 d. Pathological reports indicated chronic appendicitis with necrotizing perforation. Followups lasted for 2-13 months (mean, 6 months), with no reports of abdominal pain, fever, incision infection, adhesive intestinal obstruction, residual appendicitis, or pelvic abscess.ConclusionsFor children with acute appendicitis complicated with periappendiceal abscess who have received conservative treatment, effective adhesiolysis within the abdominal and pelvic cavities during selective laparoscopic appendectomy is crucial, which is also the primary reason for a relatively prolonged surgical time. Adhesions are primarily located between the omentum and pelvic sidewall, between the ileocecal region and omentum, and between the appendix and lateral peritoneum as well as the mesentery of the terminal ileum. Adequate adhesiolysis followed by appendectomy can effectively alleviate symptoms such as abdominal pain.

参考文献/References:

[1]张松,贾慧敏.儿童阑尾周围脓肿保守治疗后管理方式的选择.中华小儿外科杂志,2024,45(2):175-179.
[2]Shinde N,Devani R,Baseer MA,et al.Study of management of appendicular abscess in children.Afr J Paediatr Surg,2020,17(3 & 4):64-67.
[3]Ali H.Factors affecting the effectiveness of conservative management of appendicular mass.Pol Przegl Chir,2021,93(3):1-5.
[4]Das BB,Nayak KN,Mohanty SK,et al.A retrospective analysis of conservative management versus early surgical intervention in appendicular lump.Cureus,2022,14(1):e21784.
[5]Shekarriz S,Keck T,Kujath P,et al.Comparison of conservative versus surgical therapy for acute appendicitis with abscess in five German hospitals.Int J Colorectal Dis,2019,34(4):649-655.
[6]Zhang Y,Stringel G,Bezahler I,et al.Nonoperative management of periappendiceal abscess in children:a comparison of antibiotics alone versus antibiotics plus percutaneous drainage.J Pediatr Surg,2020,55(3):414-417.

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

文章信息/Info

参考文献/References:

备注/Memo

常用功能

导航/Navigate

工具/Tools

统计/Statistics