背景:本研究旨在评估腹膜引流及其类型对预后的影响,包括术后恢复和并发症,根据阑尾炎的等级,阑尾切除术后的儿科患者(≤16岁)。
方法:在这项回顾性研究中,我们分析了2017年1月至2024年1月在我们中心符合纳入和排除标准的阑尾炎儿科患者(≤16岁),并根据阑尾炎的等级将其分为I-V级,V代表最严重的病例。根据引流状态和类型对患者进行分组。主要临床结果包括术后康复指标,如恢复软饮食的时间,时间来删除排水,术后抗生素使用时间和住院时间(LOH),以及术后并发症,包括腹内脓肿(IAA),肠梗阻和伤口感染(WI),手术后30天内再入院。
结果:共有385例阑尾炎患儿被纳入研究,并分为无引流(ND)组(n=74),根据引流状态和类型,被动引流(PD)组(n=246)和主动引流(AD)组(n=65)。与其他两组相比,ND组恢复软饮食的时间明显较短,术后抗生素使用和LOH的持续时间,这些差异具有统计学意义。在I级患者中也观察到类似的发现(P<0.05)。在这里检查的所有案例中,与PD组相比,AD组的引流时间明显缩短(3.04[1-12]vs2.74[1-15],P=0.049);这种差异在I级患者中也很明显(2.80[1-6]vs2.47[1-9],P=0.019)。此外,在同一年级内,与PD组相比,仅在IV级AD组的术后抗生素使用时间较短(4.75[4-5]vs8.33[5-15],P=0.009)。此外,AD组LOH长于PD组(8.00[4-13]vs4.75[4-5],P=0.025)。在所有案件中,与其他两组相比,ND组的总体并发症和WI的发生率显着降低(P<0.05)。此外,ND组IAA发生率明显低于PD组(0%vs5.3%,P=0.008<0.0167)。此外,尽管总体并发症的发生率没有统计学上的显着差异,IAA,肠梗阻,在≥II级分析期间,PD组和AD组之间的WI(P>0.05),与AD组相比,PD组30天内的再入院率较高;差异无统计学意义(P>0.05)。此外,多变量分析显示,较高的阑尾炎级别与总体并发症和IAA的风险增加以及术后抗生素使用和LOH的持续时间更长相关。
结论:阑尾炎分级是预测术后IAA和LOH的重要指标。在I级阑尾炎患者中,腹膜引流,即使主动排水,不推荐;对于≥II级阑尾炎患者,主动引流在减少术后抗生素使用时间和LOH方面可能比被动引流更有效.
BACKGROUND: This
study aimed to assess the impact of peritoneal drainage and its type on prognosis, encompassing postoperative recovery and complications, in pediatric patients (≤ 16 years old) following appendectomy based on the grade of appendicitis.
METHODS: In this retrospective
study, we analyzed pediatric patients (≤ 16 years old) with appendicitis who met the inclusion and exclusion criteria in our center from January 2017 to January 2024 and classified them into grade I-V based on the grade of appendicitis, with V representing the most serious cases. The patients were grouped according to drainage status and type. The main clinical outcomes included postoperative rehabilitation indexes such as time to resume a soft diet, time to remove the drain, duration of postoperative antibiotic use and length of hospitalization (LOH), as well as postoperative complications including intra-abdominal abscess (IAA), ileus and wound infection (WI), and readmission within 30 days after surgery.
RESULTS: A total of 385 pediatric patients with appendicitis were included in the
study and divided into No-drainage (ND) group (n = 74), Passive drainage (PD) group (n = 246) and Active drainage (AD) group (n = 65) according to drainage status and type. Compared to the other two groups, the ND group had a significantly shorter time to resume a soft diet, duration of postoperative antibiotic use and LOH, and these differences were statistically significant. Similar findings were observed in grade I patients too (P < 0.05). In all cases examined here, the AD group had a significantly shorter time for drain removal compared to the PD group (3.04 [1-12] vs 2.74 [1-15], P = 0.049); this difference was also evident among grade I patients (2.80 [1-6] vs 2.47 [1-9], P = 0.019). Furthermore, within the same grade, only in grade IV did the AD group exhibit a shorter duration of postoperative antibiotic use compared to the PD group (4.75 [4-5] vs 8.33 [5-15], P = 0.009). Additionally, the LOH in the AD group was longer than that in the PD group (8.00 [4-13] vs 4.75 [4-5], P = 0.025). Among all cases, the ND group exhibited significantly lower incidences of overall complications and WI compared to the other two groups (P < 0.05). Additionally, the incidence of IAA in the ND group was significantly lower than that in the PD group (0% vs 5.3%, P = 0.008 < 0.0167). Furthermore, although there were no statistically significant differences in the incidence of overall complications, IAA, ileus, and WI between the PD and AD groups during grade ≥ II analysis (P > 0.05), a higher readmission rate within 30 days was observed in the PD group compared to the AD group; however, these differences were not statistically significant (P > 0.05). Moreover, multivariate analysis revealed that a higher grade of appendicitis was associated with an increased risk of overall complications and IAA as well as a longer duration of postoperative antibiotic use and LOH.
CONCLUSIONS: The appendicitis grade is a crucial indicator for predicting postoperative IAA and LOH. In patients with grade I appendicitis, peritoneal drainage, even if active drainage, is not recommended; For patients with grade ≥ II appendicitis, active drainage may be more effective than passive drainage in reducing the duration of postoperative antibiotic use and LOH.