Zhang Yalong,Lin Yan,Hui Yaxing,et al.Application of modified endoscopic retrograde appendicitis therapy for acute uncomplicated appendicitis in children[J].Journal of Clinical Pediatric Surgery,,22():272-277.[doi:10.3760/cma.j.cn101785-202209047-013]
Application of modified endoscopic retrograde appendicitis therapy for acute uncomplicated appendicitis in children
- Abstract:
- Objective To evaluate the efficacy and safety of modified endoscopic retrograde appendicitis therapy (mERAT) for acute uncomplicated appendicitis in children.Methods From October 2018 to May 2021,clinical data were retrospectively reviewed for 228 hospitalized children of acute uncomplicated appendicitis.They were followed up by telephone and outpatient and inpatient electronic information systems in June 2022.The follow-up time was 19(15,22) months.Clinical profiles,treatment success rate,recurrence within 1 year of cured and discharged children,operative duration,total hospitalization time,hospitalization time after mERAT,hospitalization expense,success rate of intubation,stent implantation rate,stent self-shedding rate,postoperative stent removal time,number of fecal stones,parasites and food seeds detected in appendix cavity and incidence of adverse events during hospitalization were summarized.Results There were 127 boys and 101 girls.Success rate of intubation was 96.9%(221/228),success rate of treatment 96.9%(221/228) and operative duration 40.0(36.0-45.0) min.Rate of stent placement was 83.3%(184/221) and rate of stent shedding 48.4%(89/184).Total hospitalization time was 3(3,4) day,hospitalization time after mERAT 2(1,3) day and total hospitalization expense 12787.0(11770.1,13585.5) yuan.Seventeen cases were lost to follow-ups and recurrence rate within 1 year was 6.9%(14/204).And the incidence of adverse events during hospitalization was 3.5%(8/228).Conclusion mERAT is both safe and effective for acute uncomplicated appendicitis in children.
References:
[1] Gorter RR,Eker HH,Gorter-Stam MA,et al.Diagnosis and management of acute appendicitis.EAES consensus development conference 2015[J].Surg Endosc,2016,30(11):4668-4690.DOI:10.1007/s00464-016-5245-7.
[2] Poprom N,Numthavaj P,Wilasrusmee C,et al.The efficacy of antibiotic treatment versus surgical treatment of uncomplicated acute appendicitis:systematic review and network meta-analysis of randomized controlled trial[J].Am J Surg,2019,218(1):192-200.DOI:10.1016/j.amjsurg.2018.10.009.
[3] Liu BR,Song JT,Han FY,et al.Endoscopic retrograde appendicitis therapy:a pilot minimally invasive technique (with videos)[J].Gastrointest Endosc,2012,76(4):862-866.DOI:10.1016/j.gie.2012.05.029.
[4] 刘向增,郭宏伟,曾令超,等.超声引导下内镜逆行性阑尾炎治疗术在儿童非复杂性阑尾炎中的应用[J].中华实用儿科临床杂志,2021,36(10):763-766.DOI:10.3760/cma.j.cn101070-20210202-00150. Liu XZ,Guo HW,Zeng LC,et al.Application of ultrasound-guided endoscopic retrograde appendicitis therapy for non-complicated appendicitisin children[J].Chin J Appl Clin Pediatr,2021,36(10):763-766.DOI:10.3760/cma.j.cn101070-20210202-00150.
[5] Kang JQ,Zhang W,Zeng LC,et al.The modified endoscopic retrograde appendicitis therapy versus antibiotic therapy alone for acute uncomplicated appendicitis in children[J].Surg Endosc,2021,35(11):6291-6299.DOI:10.1007/s00464-020-08129-8.
[6] Di Saverio S,Birindelli A,Kelly MD,et al.WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis[J].World J Emerg Surg,2016,11:34.DOI:10.1186/s13017-016-0090-5.
[7] Snyder MJ,Guthrie M,Cagle S.Acute appendicitis:efficient diagnosis and management[J].Am Fam Physician,2018,98(1):25-33.
[8] Talan DA,Di Saverio S.Treatment of acute uncomplicated appendicitis[J].N Engl J Med,2021,385(12):1116-1123.DOI:10.1056/NEJMcp2107675.
[9] Rentea RM,Peter SDS,Snyder CL.Pediatric appendicitis:state of the art review[J].Pediatr Surg Int,2017,33(3):269-283.DOI:10.1007/s00383-016-3990-2.
[10] 冯伟,赵旭峰,崔华雷.儿童急性阑尾炎病因学研究进展[J].临床小儿外科杂志,2021,20(6):592-596.DOI:10.12260/lcxewkzz.2021.06.016. Feng W,Zhao XF,Cui HL.Advances of etiology about acute appendicitis in children[J].J Clin Ped Sur,2021,20(6):592-596.DOI:10.12260/lcxewkzz.2021.06.016.
[11] López JJ,Deans KJ,Minneci PC.Nonoperative management of appendicitis in children[J].Curr Opin Pediatr,2017,29(3):358-362.DOI:10.1097/MOP.0000000000000487.
[12] Vitetta L,Chen JZ,Clarke S.The vermiform appendix:an immunological organ sustaining a microbiome inoculum[J].Clin Sci (Lond),2019,133(1):1-8.DOI:10.1042/CS20180956.
[13] Song MY,Ullah S,Yang HY,et al.Long-term effects of appendectomy in humans:is it the optimal management of appendicitis?[J].Expert Rev Gastroenterol Hepatol,2021,15(6):657-664.DOI:10.1080/17474124.2021.1868298.
[14] Styrud J,Eriksson S,Nilsson I,et al.Appendectomy versus antibiotic treatment in acute appendicitis.a prospective multicenter randomized controlled trial[J].World J Surg,2006,30(6):1033-1037.DOI:10.1007/s00268-005-0304-6.
[15] Hansson J,K?rner U,Khorram-Manesh A,et al.Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients[J].Br J Surg,2009,96(5):473-481.DOI:10.1002/bjs.6482.
[16] Armstrong J,Merritt N,Jones S,et al.Non-operative management of early,acute appendicitis in children:is it safe and effective?[J].J Pediatr Surg,2014,49(5):782-785.DOI:10.1016/j.jpedsurg.2014.02.071.
[17] Svensson JF,Patkova B,Almstr?m M,et al.Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children:a pilot randomized controlled trial[J].Ann Surg,2015,261(1):67-71.DOI:10.1097/SLA.0000000000000835.
[18] Gorter RR,van der Lee JH,Heijsters FACJ,et al.Outcome of initially nonoperative treatment for acute simple appendicitis in children[J].J Pediatr Surg,2018,53(9):1849-1854.DOI:10.1016/j.jpedsurg.2017.12.012.
[19] Kashtan MA,Graham DA,Melvin P,et al.Ceftriaxone combined with metronidazole is superior to cefoxitin alone in the management of uncomplicated appendicitis in children:results from a multicenter collaborative comparative effectiveness study[J].Ann Surg,2021,274(6):e995-e1000.DOI:10.1097/SLA.0000000000003704.
[20] Perez Otero S,Metzger JW,Choi BH,et al.It’s time to deconstruct treatment-failure:a randomized controlled trial of nonoperative management of uncomplicated pediatric appendicitis with antibiotics alone[J].J Pediatr Surg,2022,57(1):56-62.DOI:10.1016/j.jpedsurg.2021.09.024.
[21] Huang LB,Yin Y,Yang L,et al.Comparison of antibiotic therapy and appendectomy for acute uncomplicated appendicitis in children:a meta-analysis[J].JAMA Pediatr,2017,171(5):426-434.DOI:10.1001/jamapediatrics.2017.0057.
[22] Mosuka EM,Thilakarathne KN,Mansuri NM,et al.A systematic review comparing nonoperative management to appendectomy for uncomplicated appendicitis in children[J].Cureus,2021,13(10):e18901.DOI:10.7759/cureus.18901.
[23] Salminen P,Paajanen H,Rautio T,et al.Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis:the APPAC randomized clinical trial[J].JAMA,2015,313(23):2340-2348.DOI:10.1001/jama.2015.6154.
[24] Salminen P,Tuominen R,Paajanen H,et al.Five-year follow-up of antibiotic therapy for uncomplicated acute appendicitis in the APPAC randomized clinical trial[J].JAMA,2018,320(12):1259-1265.DOI:10.1001/jama.2018.13201.
[25] Flum DR,Davidson GH,Monsell SE,et al.A randomized trial comparing antibiotics with appendectomy for appendicitis[J].N Engl J Med,2020,383(20):1907-1919.DOI:10.1056/NEJMoa2014320.
[26] Minneci PC,Hade EM,Lawrence AE,et al.Association of nonoperative management using antibiotic therapy vs laparoscopic appendectomy with treatment success and disability Days in children with uncomplicated appendicitis[J].JAMA,2020,324(6):581-593.DOI:10.1001/jama.2020.10888.
[27] 刘冰熔,王宏光,孙相钊,等.内镜逆行阑尾炎治疗术应用多中心回顾性分析[J].中华消化内镜杂志,2016,33(8):514-518.DOI:10.3760/cma.j.issn.1007-5232.2016.08.003. Liu BR,Wang HG,Sun XZ,et al.Retrospective analysis of endoscopic retrograde appendicitis therapy for acute appendicitis in China[J].Chin J Dig Endosc,2016,33(8):514-518.DOI:10.3760/cma.j.issn.1007-5232.2016.08.003.
[28] 沈文拥,唐静,吴涛,等.急性阑尾炎保守治疗与内镜下逆行治疗的疗效对比研究[J].海南医学,2020,31(24):3208-3210.DOI:10.3969/j.issn.1003-6350.2020.24.023. Shen WY,Tang J,Wu T,et al.Comparative study on efficacy of conservative treatment and endoscopic retrograde appendicitis treatment for acute appendicitis[J].Hainan Med J,2020,31(24):3208-3210.DOI:10.3969/j.issn.1003-6350.2020.24.023.
[29] Altun E,Avci V,Azatcam M.Parasitic infestation in appendicitis.A retrospective analysis of 660 patients and brief literature review[J].Saudi Med J,2017,38(3):314-318.DOI:10.15537/smj.2017.3.18061.
[30] Li MH,Kong LJ,Liu BR.Missing plastic stent,an unreported complication of endoscopic retrograde appendicitis therapy[J].Gastroenterology,2022,162(6):e10-e11.DOI:10.1053/j.gastro.2021.09.032.
[31] 黄勤,刘冰熔,方从诚,等.内镜下阑尾切除术一例[J].中华消化内镜杂志,2018,35(6):444-445.DOI:10.3760/cma.j.issn.1007-5232.2018.06.020. Huang Q,Liu BR,Fang CC,et al.Endoscopic appendectomy:one case report[J].Chin J Dig Endosc,2018,35(6):444-445.DOI:10.3760/cma.j.issn.1007-5232.2018.06.020.
[32] Song MY,Ullah S,Liu BR.Endoscopic retrograde appendicitis therapy for treating periappendiceal abscess:first human case report[J].Am J Gastroenterol,2021,116(6):1119.DOI:10.14309/ajg.0000000000001116.
[33] Kong LJ,Liu D,Zhang JY,et al.Digital single-operator cholangioscope for endoscopic retrograde appendicitis therapy[J].Endoscopy,2022,54(4):396-400.DOI:10.1055/a-1490-0434.
Memo
收稿日期:2022-9-28。
基金项目:陕西省基金一般项目,社发重点项目(2022SF-082);陕西省卫生健康科研项目(2021E008);空军军医大学第二附属医院临床研究重大项目(2021LCYJ009)
通讯作者:江逊,Email:863756276@qq.com