■最近的研究表明,儿童阑尾切除术后脓肿(PAA)的特定病例可以保守治疗。然而,由于缺乏高质量的证据,治疗的选择仍然取决于治疗外科医生的偏好,导致临床实践中的异质性。因此,我们旨在提供有关儿童PAA治疗的最新文献的最新资料,并随后评估接受PAA治疗的大型多中心儿童队列的结局.
■在Pubmed和Embase中进行了文献检索,选择所有随机对照试验,前瞻性和回顾性队列研究,以及从2014年及以后发布的病例系列,并报告了接受PAA治疗的儿童(<18岁)。随后,进行了一项历史队列研究,包括2014年至2021年间在三级转诊中心和两个大型外围中心接受放射学证实的PAA治疗的所有儿童(<18岁)。对医学图表进行了审查,以比较非侵入性(即,抗生素)和侵入性(即,引流程序)处理策略。主要结果是治疗成功率,定义为不需要与PAA或其并发症相关的进一步干预。
■搜索产生了1,991篇文章,其中包括三个。非侵入性和侵入性策略的治疗成功率在69-88%和56-100%之间。分别。我们的多中心队列研究包括70名患有PAA的儿童,其中29例(41%)接受非侵入性治疗,41例(59%)接受侵入性治疗。在非侵入性组中,治疗有效的患者有21例(72%),而侵入性治疗组有25例(61%).非侵入性治疗对100%的单焦小(<3厘米)和80%的单焦中型PAA(3-6厘米)有效,但对多发性脓肿无效。
■非侵入性治疗儿童特别是单焦中小型(<6cm)PAA似乎是安全有效的。基于这些结果,制定了标准化的治疗方案.建议对这种基于逐步方法的治疗方案进行前瞻性验证。
UNASSIGNED: Recent studies have shown that specific cases of post-appendectomy abscess (PAA) in children could be treated conservatively. However, due to the lack of high-quality evidence, choice of treatment still depends on preferences of the treating surgeon, leading to heterogeneity in clinical practice. Therefore, we aimed to provide an update of recent literature on the management of PAA in children and subsequently evaluate the outcomes of a large multicenter cohort of children treated for PAA.
UNASSIGNED: A literature search was performed in Pubmed and Embase, selecting all randomized controlled trials, prospective and retrospective cohort studies, and case series published from 2014 and onward and reporting on children (<18 years) treated for a PAA. Subsequently, a historical cohort
study was performed, including all children (<18 years) treated for a radiologically confirmed PAA between 2014 and 2021 in a tertiary referral center and two large peripheral centers. Medical charts were reviewed to compare non-invasive (i.e., antibiotics) and invasive (i.e., drainage procedures) treatment strategies. Primary outcome was the success rate of treatment, defined as no need for further interventions related to PAA or its complications.
UNASSIGNED: The search yielded 1,991 articles, of which three were included. Treatment success ranged between 69-88% and 56-100% for non-invasive and invasive strategies, respectively. Our multicenter cohort
study included 70 children with a PAA, of which 29 (41%) were treated non-invasively and 41 (59%) invasively. In the non-invasive group, treatment was effective in 21 patients (72%) compared to 25 patients (61%) in the invasive group. Non-invasive treatment was effective in 100% of unifocal small (<3 cm) and 80% of unifocal medium size PAA (3-6 cm), but not effective for multiple abscesses.
UNASSIGNED: Non-invasive treatment of especially unifocal small and medium size (<6 cm) PAA in children seems to be safe and effective. Based on these results, a standardized treatment protocol was developed. Prospective validation of this step-up approach-based treatment protocol is recommended.