女童阑尾炎术后输卵管脓肿3例报道并文献复习

Fallopian tubal abscess after appendectomy in girls:report of 3 cases and review of literature

目的:探讨女童阑尾炎术后发生输卵管脓肿的病因、诊断及治疗。方法:回顾性分析郑州大学第一附属医院2017年1月至2020年1月收治的3例阑尾炎术后并发输卵管脓肿女童的临床资料,3例女童明确诊断后均行彩超引导下穿刺置管术,给予脓腔冲洗引流,同时静脉输注三代头孢类抗生素和奥硝唑针。文献检索女童阑尾炎术后并发输卵管脓肿的诊治病例。结果:3例女童经治疗后均痊愈出院,出院时血常规正常,有1例CRP稍高,出院后随访12个月,无腹痛、发热症状,无脓肿复发。文献检索共发现5例女童,年龄14~17岁,化脓性阑尾炎4例,坏疽性阑尾炎1例,均有穿孔;阑尾炎术后时间2个月~3 a;入院均有腹痛,伴发热2例,伴排尿困难2例;右侧输卵管脓肿3例,右侧输卵管积脓并输卵管炎2例。5例均手术治疗;2例术后病理分别示化脓性输卵管炎及输卵管内部分钙化的粪石、慢性滤泡性输卵管炎。结论:女童阑尾炎术后,出现腹痛、发热,要警惕输卵管脓肿发生可能,尤其是青春期的女孩。超声结合盆腔CT或MRI可以明确诊断,彩超引导下脓肿穿刺置管外引流可以取得满意的疗效,避免盲目二次手术。

Aim:To investigate the etiology,diagnosis and treatment of fallopian tubal abscess after appendectomy in girls.Method:The clinical data of 3 girls with fallopian tubal abscess after appendectomy admitted to the First Affiliated Hospital of Zhengzhou University from January 2017 to January 2020 were retrospectively analyzed.After the diagnosis,the 3 girls received puncture and catheterization guided by color ultrasound,abscess cavity flushing and drainage.At the same time,the third-generation cephalosporins and ornidazole were intravenously injected.The literature related to the diagnosis and treatment of fallopian tubal abscess after appendectomy in girls were reviewed.Results:After treatment,all the 3 girls were cured and discharged,with normal blood routine at discharge,and 1 girl had a slightly higher CRP.During the follow-up of 12 months after discharge,no abdominal pain,fever or recurrence of fallopian tubal abscess was found.A literature search revealed 5 cases of girls aged 14-17 years,including 4 cases of suppurative appendicitis and 1 case of gangrenous appendicitis,all with perforation.Postoperative time for appendicitis was 2 months-3 years;all patients had abdominal pain,fever in 2 cases and dysuria in 2 cases.There were 3 cases of right fallopian tubal abscess,2 cases of right pyosalpix and salpingitis.All 5 cases were treated by operation.Postoperative pathology of 2 cases showed suppurative salpingitis,partially calcified coprolites and chronic follicular salpingitis.Conclusion:After appendectomy in girls,abdominal pain and fever suggest the possibility of fallopian tubal abscess,especially adolescent girls.Ultrasound combined with pelvic CT or MRI can make a clear diagnosis.Abscess puncture and catheter drainage guided by color ultrasound can achieve satisfactory efficacy and avoid hasty secondary surgery.