儿童穿孔性阑尾炎宜立即手术

别**料

　近期，Medscape评出了2011年外科领域最佳研究。以下为其中之一。

　　摘要：儿童穿孔性阑尾炎的最佳治疗策略是什么？研究者对131例疑似穿孔性阑尾炎患者随机立即或延迟进行阑尾切除术。患者平均年龄约为10岁，症状持续约3.4天，大部分接受了CT诊断检查。结果显示，早期切除阑尾可显著缩短恢复正常日常活动的时间，显著降低不良事件发生率。

链接：
Blakely ML, Williams R, Dassinger MS, et al. Early vs interval appendectomy for children with perforated appendicitis. Arch Surg. 2011;146:660-665.

Martin L. Blakely, MD, MS; Regan Williams, MD; Melvin S. Dassinger, MD; James W. Eubanks III, MD; Peter Fischer, MD, MS; Eunice Y. Huang, MD, MS; Elizabeth Paton, PNP; Barbara Culbreath, BSN, CCRC; Allison Hester, PNP; Christian Streck, MD; S. Douglas Hixson, MD; Max R. Langham Jr, MD


Arch Surg. 2011;146(6):660-665. doi:10.1001/archsurg.2011.6

Objective  To compare the effectiveness and adverse event rates of early vs interval appendectomy in children with perforated appendicitis.

Design  Nonblinded randomized trial.

Setting  A tertiary-referral urban children's hospital.

Patients  A total of 131 patients younger than 18 years with a preoperative diagnosis of perforated appendicitis.

Interventions  Early appendectomy (within 24 hours of admission) vs interval appendectomy (6-8 weeks after diagnosis).

Main Outcome Measures  Time away from normal activities (days). Secondary outcomes included the overall adverse event rates and the rate of predefined specific adverse events (eg, intra-abdominal abscess, surgical site infection, unplanned readmission).

Results  Early appendectomy, compared with interval appendectomy, significantly reduced the time away from normal activities (mean, 13.8 vs 19.4 days; P < .001). The overall adverse event rate was 30% for early appendectomy vs 55% for interval appendectomy (relative risk with interval appendectomy, 1.86; 95% confidence interval, 1.21-2.87; P = .003). Of the patients randomized to interval appendectomy, 23 (34%) had an appendectomy earlier than planned owing to failure to improve (n = 17), recurrent appendicitis (n = 5), or other reasons (n = 1).

Conclusions  Early appendectomy significantly reduced the time away from normal activities. The overall adverse event rate after early appendectomy was significantly lower compared with interval appendectomy.

Trial Registration  clinicaltrials.gov Identifier: NCT00435032


Author Affiliations: Division of Pediatric Surgery (Drs Blakely, Williams, Eubanks, Fischer, Huang, Hixson, and Langham and Ms Paton) and Pediatric Clinical Research Center (Ms Culbreath), University of Tennessee Health Science Center, Memphis; Division of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock (Dr Dassinger and Ms Hester); and Division of Pediatric Surgery, Medical University of South Carolina, Charleston (Dr Streck).

刘***夫

摘要：儿童穿孔性阑尾炎的最佳治疗策略是什么？楼主的帖子 是否  编辑下？？？？

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儿童阑尾炎容易漏诊，发现越早，有手术适应证得应尽早手术，避免耽误