Appendiceal Abscess: Immediate Operation or Percutaneous Drainage?
Appendiceal Abscess: Immediate Operation or Percutaneous Drainage?
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阑尾脓肿：立即手术还是经皮引流？
DOI：
10.1177/000313480306901002
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
G. Velmahos
中科院分区：
文献类型：
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作者：
Carlos V. R. Brown;M. Abrishami;M. Muller;G. Velmahos
关于脓肿并发急性阑尾炎的最佳治疗方法，存在相互矛盾的证据。本研究的目的是比较立即阑尾切除术(IMM APP)和期待疗法(EXP MAN)治疗阑尾周围脓肿的疗效，包括经皮引流加或不加间歇性阑尾切除术。本文报告104例急性阑尾炎并阑尾周围脓肿。我们比较了36例接受IMM APP的患者和68例接受EXP MAN的患者。结果测量包括发病率和住院时间。两组在年龄(30.6±12.3比34.8±13.5岁)、性别(61%比62%男性)、入院白细胞计数(17.5±5.1×103个/dL比17.0±4.8×103个/dL)和入院温度(37.9±1.2比37.8±0.9°F)方面相似。IMM APP患者首次住院时的并发症发生率(58%比15%，P<；0.001)和所有住院期间的并发症发生率(67%比24%，P<；0.001)均高于Exp MAN患者。IMM APP组首次住院天数(14.8±16.1天)和总住院天数(15.3±16.2天)较长(P=0.04)。我们得出结论，对于阑尾脓肿的治疗，经皮引流和间隔阑尾切除术优于立即阑尾切除术，因为它导致较低的并发症发生率和较短的住院时间。
Conflicting evidence exists regarding the optimal treatment for abscess complicating acute appendicitis. The objective of this study is to compare immediate appendectomy (IMM APP) versus expectant management (EXP MAN) including percutaneous drainage with or without interval appendectomy to treat periappendiceal abscess. One hundred four patients with acute appendicitis complicated by periappendiceal abscess were identified. We compared 36 patients who underwent IMM APP with 68 patients who underwent EXP MAN. Outcome measures included morbidity and length of hospital stay. The groups were similar with regard to age (30.6 ± 12.3 vs. 34.8 ± 13.5 years), gender (61% vs. 62% males), admission WBC count (17.5 ± 5.1 x 103 vs. 17.0 ± 4.8 x 103 cells/dL), and admission temperature (37.9 ± 1.2 vs. 37.8 ± 0.9°F). IMM APP patients had a higher rate of complications than EXP MAN patients at initial hospitalization (58% vs. 15%, P < 0.001) and for all hospitalizations (67% vs. 24%, P < 0.001). The IMM APP group also had a longer initial (14.8 ± 16.1 vs. 9.0 ± 4.8 days, P = 0.01) and overall hospital stay (15.3 ± 16.2 vs. 10.7 ± 5.4 days, P = 0.04). We conclude that percutaneous drainage and interval appendectomy is preferable to immediate appendectomy for treatment of appendiceal abscess because it leads to a lower complication rate and a shorter hospital stay.