背景:在澳大利亚,腹腔镜阑尾切除术通常用于治疗急性阑尾炎。腹内脓肿(IAA)是急性阑尾炎阑尾切除术后的潜在并发症。术后发生IAA的危险因素仍存在争议且定义不清。对于出现包括IAA在内的并发症的患者,可以进行腹腔镜冲洗。这项研究的目的是确定IAA发展的危险因素,并确定阑尾切除术后可能需要腹腔镜冲洗的患者。
方法:数据来自在5年期间(2012-2017年)接受腹腔镜阑尾切除术的423例患者。临床(发烧,血流动力学,检查结果),生化(白细胞计数,中性粒细胞计数,C反应蛋白,胆红素,白蛋白),放射学(CT游离液),和手术因素(炎症,化脓,自由流体,穿孔,组织病理学)收集在前,pery-,和术后期间进行分析。
结果:23例(5.4%)患者术后发生IAA。在发生IAA的患者和需要腹腔镜冲洗的患者中,静脉注射抗生素的持续时间明显更长(p<0.0001)。发生IAA或需要腹腔镜冲洗的患者入院时C反应蛋白(CRP)(p<0.05)和阑尾穿孔(p=0.0005)明显更高。没有临床或放射学发现可以预测IAA的发展或需要腹腔镜冲洗。
结论:入院时CRP升高可以预测术后IAA形成的发展或阑尾切除术后腹腔镜冲洗的需要。术后抗生素的长期使用似乎与IAA的发展以及腹腔镜冲洗的需要无关。这些数据强调了阑尾切除术后围手术期抗生素使用的明确指南的必要性。
BACKGROUND: Laparoscopic appendicectomy is commonly performed in Australia for treatment of acute appendicitis. Intra-abdominal abscess (IAA) is a potential complication following appendicectomy for acute appendicitis. Risk factors for developing post-operative IAA remain controversial and poorly defined. Laparoscopic washout may be performed for patients who develop complication(s) including IAA. The aim of this study was to define risk factors for both the development of IAA and identify patients who may require laparoscopic washout following appendicectomy.
METHODS: Data were obtained from 423 patients who underwent laparoscopic appendicectomy over a five-year period (2012-2017). Clinical (fever, haemodynamics, examination findings), biochemical (white cell count, neutrophil count, C-reactive protein, bilirubin, albumin), radiological (CT free fluid), and operative factors (inflammation, suppuration, free-fluid, perforation, histopathology) collected in the pre-, peri-, and post-operative period(s) were analysed.
RESULTS: 23 (5.4%) patients developed post-operative IAA. Duration of intravenous antibiotics was significantly longer in patients who developed IAA and in those who required laparoscopic washout (p < 0.0001). C-reactive protein (CRP) on admission (p < 0.05) and appendiceal perforation (p = 0.0005) were significantly higher in patients who either developed IAA or needed laparoscopic washout. No clinical or radiological finding predicted either the development of IAA or need for laparoscopic washout.
CONCLUSIONS: Elevated CRP on admission may predict the development of post-operative IAA formation or the need for laparoscopic washout post-appendicectomy. Prolonged post-operative antibiotic use appears independent of the development of IAA as well as the need for laparoscopic washout. These data highlight the need for clear guidelines on peri-operative antibiotic use following appendicectomy.