儿童阑尾周围脓肿保守治疗后管理方式的选择

Managements after non-operative treatment of periappendiceal abscess in children

儿童阑尾炎并发阑尾周围脓肿的治疗方式一直存在争议。在急性阑尾炎并发阑尾周围脓肿的病例中,当患儿出现弥漫性腹膜炎和全身中毒症状时首选急诊手术治疗。除此之外,保守治疗广泛应用于并发阑尾周围脓肿患儿的早期治疗中。大量研究证实了保守治疗的安全性和有效性,成功率高达80%~97%,并且保守治疗成功后,复发概率较低,约2%~34%。本研究对儿童急性阑尾炎并发阑尾周围脓肿的保守治疗及好转后管理方式的选择进行综述,建议保守治疗好转后的管理方式可优先选择积极随访观察,不必常规进行择期阑尾切除术,存在复发风险因素的患儿需提高警惕或建议择期阑尾切除术。

Proper treatment for acute appendicitis complicated with periappendiceal abscess in children has been controversial.Emergency surgery is usually a first choice for cases of gross peritonitis or systemic poisoning.And initial non-operative treatment is widely applied for periappendiceal abscess with a success rate of 80%-97%.Non-operative treatment is both safe and efficacious with a low recurrence rate of 2%-34%.This review focused upon initial successful non-operative treatment and subsequent managements for acute appendicitis complicated with periappendiceal abscess in children.It is recommended that active follow-up observations should be prioritized after conservative treatments.And there is no necessity for routine elective appendectomy.Children with risk factors for recurrence should be closely watched or elective appendectomy performed as needed.