小儿阑尾周围脓肿61例临床分析

Analysis of the treating experience of 61 children with appendicular abscess

目的总结19年来北京大学第一医院对于小儿阑尾周围脓肿的治疗经验，探讨治疗策略的变化。方法回顾性分析自1993年至2011年间，作者收治的61例阑尾周围脓肿患儿临床资料。治疗方法包括静脉输入抗生素、理疗、B超引导下脓肿穿刺及手术治疗。结果保守治疗32例，1例于4周后发生肠梗阻，1例1年后再发脓肿；B超引导下行脓肿穿刺4例，无并发症；手术25例（10例行脓肿切开引流并切除阑尾，其余行脓肿切开引流），出现并发症（切口感染、肠梗阻、残余脓肿）11例。4例于随访期间发作急性阑尾炎，予手术切除阑尾，其中3例存在阑尾粪石。结论对于阑尾周围脓肿，应首选以静脉输入抗生素为主的保守治疗方法；对于部分脓肿较大的患儿，可在B超引导下行穿刺引流。存在阑尾粪石的患儿，应行二期阑尾切除术。

Objective To summarize the 19 - year clinical experience of appendicular abscess in children in our hospital, and to study the change of the treating strategy. Methods We retrospectively analyzed 61 children with appendicnlar abscess which was admitted from 1993 to 2011 in our hospital. They were treated by intravenous antibiotics,physical therapy,sonography guided drainage and operations. Results 32 patients underwent conservative therapy, among which one patient complicated with bowel obstruction 4 weeks after initial therapy and one patient had appendicnlar abscess again 1 year after initial therapy. Sonography guided drainage was completed in 4 patients, and there was no complication. 25 patients underwent operation （ 10 patients underwent abscess incision drainage and appendectomy ,while the other 15 patients underwent abscess incision drainage only）. The operation complications which included incision infection, bowel obstruction and residual abscess occurred in 11 patients. 4 patients had acute appendicitis in the follow-up period, and received appendectomy. Among the 4 patients, appendicoliths were present in 3 of them. Conclusions Conservative therapy with intravenous antibiotics is of first choice in the treatment of children with appendicular abscess. For children with a big abscess, sonography guided drainage should be recommended. Selective appendectomy should be performed in patients presenting with an appendicolith.