Jiang Ying,Zhao Xiangyou,Deng Keheng,et al.Comparative study of different treatment methods for pediatric periappendiceal abscess[J].Journal of Clinical Pediatric Surgery,2025,(11):1069-1073.[doi:10.3760/cma.j.cn101785-202503115-015]
不同方法治疗儿童阑尾周围脓肿的对比研究
- Title:
- Comparative study of different treatment methods for pediatric periappendiceal abscess
- Keywords:
- Abscess; Appendicitis; Laparoscopy; Ultrasound Guidance; Antibiotics
- 摘要:
- 目的 比较腹腔镜下脓肿引流(laparoscopic abscess drainage,LAD)+抗生素治疗(antibiotic therapy,AT)、超声引导下脓肿引流(ultrasound-guided abscess drainage,UGAD)+AT和单纯AT 3种治疗方案对小儿阑尾周围脓肿的治疗效果。方法 回顾性分析2020年7月至2023年6月宜昌市中心人民医院收治的103例阑尾周围脓肿患儿的临床资料,根据不同治疗方式分为LAD+AT组(n=23)、UGAD+AT组(n=36)和AT组(n=44),对三组基线资料(性别、年龄、发病时间、脓肿直径、入院白细胞计数)、治疗效果(体温恢复正常时间、白细胞恢复正常时间、C反应蛋白恢复正常时间、抗生素使用时间、住院时间、住院费用、脓肿复发率、Ⅱ期手术疗效)进行对比分析。结果 三组基线资料差异无统计学意义(P>0.05)。AT组体温恢复时间[(4.6±1.6)d]、白细胞恢复时间[(7.2±1.5)d]、CRP恢复时间[(9.6±2.1)d]、抗生素使用时间[(13.3±1.3)d]、住院时间[(16.9±3.9)d]均显著长于LAD+AT组[(3.3±1.3)d、(5.3±1.1)d、(7.1±1.7)d、(5.6±1.1)d、(10.2±4.3)d]及UGAD+AT组[(2.9±0.78)d、(5.5±1.2)d、(7.4±2.0)d、(5.8±0.9)d、(9.6±3.8)d],差异有统计学意义(P<0.05);LAD+AT组住院费用[(13 258±2 057)元]显著高于UGAD+AT组[(8 762±1 109)元]及AT组[(7 794±938)元],差异有统计学意义(P<0.05);AT组脓肿复发率(15.9%)显著高于LAD+AT组、UGAD+AT组(0%、2.8%),差异有统计学意义(P<0.05)。结论 UGAD+AT治疗效果好、恢复快、治疗费用低,是一种较为安全有效的小儿阑尾周围脓肿治疗方式。对于一些不适合行UGAD的脓肿,LAD+AT可以作为备选方案,同样可以取得比较理想的疗效。尽早采用合适的脓肿引流术,再配合AT,可以作为小儿阑尾周围脓肿治疗的理想方案。
- Abstract:
- Objective To compare the therapeutic effects of laparoscopic abscess drainage (LAD) plus antibiotic therapy (AT),ultrasound-guided abscess drainage (UGAD) plus AT,and AT alone in children with periappendiceal abscess. Methods The clinical data of 103 children with periappendiceal abscesses admitted to Yichang Central People’s Hospital from July 2020 to June 2023 were retrospectively analyzed.According to the treatment modality,they were divided into LAD+AT group (n=23),UGAD+AT group (n=36),and AT group (n=44).Baseline characteristics (gender,age,duration of illness,abscess diameter,and leukocyte count on admission) and treatment outcomes (time to normalization of body temperature,white blood cell count,and C-reactive protein; duration of antibiotic use; length of hospital stay; hospitalization costs; abscess recurrence rate; and outcome of interval appendectomy) were compared among the three groups. Results No significant differences were found in baseline characteristics among the three groups (P>0.05).Regarding efficacy indicators,the AT group had significantly longer times to normalization of temperature [(4.6±1.6) days],white blood cell [(7.2±1.5) days],and CRP [(9.6±2.1) days],as well as longer antibiotic courses [(13.3±1.3) days]and hospital stays [(16.9±3.9) days],than both the LAD+AT group [(3.3±1.3) days,(5.3±1.1) days,(7.1±1.7) days,(5.6±1.1) days,(10.2±4.3) days]and UGAD+AT group [(2.9±0.78) days,(5.5±1.2) days,(7.4±2.0) days,(5.8±0.9) days,(9.6±3.8) days](P<0.05).Hospitalization cost in the LAD+AT group [(13,258±2,057) yuan]was significantly higher than in the UGAD+AT [(8,762±1,109) yuan]and AT [(7,794±938) yuan]groups (P<0.05).The abscess recurrence in the AT group (15.9%) was markedly higher than in the other two groups (0%,2.8%) (P<0.05). Conclusions The combination of UGAD and antibiotic therapy provides effective treatment with faster recovery and lower cost,making it a safe and efficient option for pediatric periappendiceal abscess.For abscesses unsuitable for ultrasound-guided drainage,LAD+AT serves as an alternative with similarly favorable outcomes.Early implementation of appropriate abscess drainage combined with antibiotic therapy represents an ideal strategy for managing pediatric periappendiceal abscess.
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备注/Memo
收稿日期:2025-3-31。
基金项目:湖北省自然基金联合基金项目(2024AFD184)
通讯作者:郭兆坤,Email:12893437@qq.com