腹腔镜与开腹阑尾切除术对比研究

目的 总结腹腔镜阑尾切除术(LA)和传统的开腹阑尾切除术(OA)的经验,探讨腹腔镜在阑尾切除术中的应用价值.方法 对123例LA与同期施行的989例OA的阑尾炎患者的临床资料进行统计、对比与分析.结果 LA组在手术时间、进食时间及住院时间较OA组明显缩短;而且在术后疼痛的程度、术后切口感染率等方面明显优于OA组;但平均住院费用明显高于OA组.结论 腹腔镜阑尾切除术具有创伤小、康复快等优点,值得推广应用.     

Appendicitis in leukemia and aplastic anemia: neutropenia not a contraindication to surgery

The management of the neutropenic child with abdominal pain can be difficult. It has been suggested that the clinical findings are unreliable in assessing the need for surgical intervention. This retrospective study of ten neutropenic children who underwent emergent appendectomy at this institution over the past 21 years suggests that careful clinical evaluation is essential in planning therapy. Pain was a universal complaint and was associated with fever in 70% of patients. Clinical assessment was correct in 80% of this group, whose mean absolute neutrophil count was 0.59±0.36 (mean ± SD) at the time of presentation. All patients survived surgery and mean hospitalization was 12.8±5.3 days. We conclude that appendectomy can be performed safely in the presence of neutropenia.     

Surgical complications in hemolytic-uremic syndrome: gangrenous appendicitis

Gastrointestinal symptoms in hemolytic-uremic syndrome are common, and usually accompany the prodrome. In rare cases the gastrointestinal manifestations take predominance, necessitating surgical intervention. Nine such cases have been reported previously. We describe a case of gangrenous appendicitis as the presenting symptom of the hemolytic-uremic syndrome. Offprint requests to: A. Szold     

Primary peritonitis in infants and children

Primary peritonitis is a diffuse in fammation of the peritoneal cavity for which there is no obvious focus of infection. During the last 15 years, at two children's hospitals, the authors have treated a total of 25 infants and children with primary peritonitis, excluding those with cirrhosis, nephrosis, or a neurosurgical ventriculoperitoneal shunt. All but one of the patients were female and 19 were between 5 and 10 years old. Presenting picture was one of the short onset with high fever, vomiting, and generalized peritonitis. The infants and children were listless and toxic, and 10 had white blood cell counts over 15,000. All were operated on with the diagnosis of ruptured appendicitis. The operative findings were typical in all cases: negative laparotomy, diffuse serositis, and cloudy, slimy peritoneal fluid. Appendectomy without drainage was performed in each case. In our series, 14 peritoneal cultures were negative, 7 grew Escherichia coli, 3 a streptococcal species, and one pneumococcus and meningococcus. The morbidity and mortality in our series was 0%; this was almost certainly due to antibiotics.Offprint requests to: S. H. Ein     

压痛最明显处横切口与麦氏切口在阑尾切除术中的对比研究

目的探讨压痛最明显处横切口在阑尾切除术中的应用价值，进一步提高阑尾炎手术治疗效果。方法将220例急性阑尾炎患者，随机分为治疗组（112例）和对照组（108例），比较两组间手术时间、下床活动时间、切口感染率、术后疼痛评分、切口美观指数和治愈率。结果两组全部治愈；治疗组手术时间明显缩短，较对照组有显著差异（P〈0．05）；治疗组术后下床活动时间较对照组明显缩短（P〈0．05）；切口感染率降低，且与对照组有明显差异（P〈0．05）；治疗组术后切121愈合美容效果好。结论压痛最明显处横切口是阑尾切除术的理想切口，比麦氏切口具有手术时间短、下床活动早、切口感染率低、切口愈合美容效果好等优点。     

儿童阑尾炎感染病原菌的分布及耐药性

目的：研究息阑尾炎儿童感染病原菌的种类、分布特征及抗生素的耐药情况。方法：采取术中阑尾炎脓液标本作培养．利用MicroScan—Wolk／40全自动微生物分析仪进行细菌鉴定和药敏实验。结果：在患阑尾炎儿童感染病原菌中，革兰阴性杆菌以大肠埃希菌、铜绿假单孢菌、肺炎克雷伯菌为主；革兰阳性菌以金黄色葡萄球菌、粪肠球菌、屎肠球菌居多。在药敏实验中。革兰阴性杆菌对亚胺硫霉素耐药率〈10％．头孢西丁、环丙氟哌酸耐药率相对较低，金黄色葡萄球菌对万古霉素无耐药株，对亚胺硫霉素、环丙氟哌酸、复方新诺明、利复平、苯唑青霉素耐药率〈10％。结论：大肠埃希菌、铜绿假单孢菌、肺炎克雷伯菌、金黄色葡萄球菌、粪肠球菌、屎肠球菌在阑尾腔内繁殖是小儿阑尾炎症的诱发因素之一，对这些病原菌药敏分析的调查，对防治术后切口感染，合理使用抗生素有重要临床意义。     

小儿炎症阑尾肌间神经丛观察

目的 探讨小儿炎症阑尾壁肌间神经节及节内神经节细胞（节内细胞）数量变化，形态以及肌间乙酰胆碱酯酶染色纤维的数量变化的意义。方法 应用HE染色对1－13岁（平均6.9岁）急性单纯性阑尾炎40例，急性化脓性阑尾炎47例，急性坏疽性阑尾炎30例及42例对照组进行观察，分别取每个标本的尖端、中部、根部三处，测定肌间神经节密度（神经节总数／周长）及节内细胞数，并对其中各类型阑尾各6级及对照组7例的肌间乙酰胆碱酯酶阳性纤维进行观察。结果 炎症阑尾肌间神经节密度及节内细胞数较对照组减少，并随炎症的加重而明显减少；同一病理类型阑尾炎，从根部至尖端两参数亦呈递减趋势，而神经节细胞的成熟度无异常。胆碱酯酶阳性纤维也随炎症加重而明显减少。结论 炎症阑尾肌间神经节密度、节内细胞及胆碱酯酶染色数目减少与阑尾炎症程度关系密切。     

Perforated appendicitis in children: to drain or not to drain?

We studied 66 children with perforated appendicitis at the University of New Mexico to determine whether or not transperitoneal drainage has any advantage in the management of these children. Patients were assigned to one or the other treatment group on the basis of the call schedule of the attending surgeons, two of whom preferred drainage and two of whom did not. Other aspects of appendicitis management (e. g., supportive care, antibiotics) were the same for both groups. Thirty-two other children who had an abscess at the time of appendectomy were excluded from the analysis. The two study groups were similar in age and severity of illness. Postoperative complications (wound infection, abdominal abscess, small-bowel obstruction) had a similar incidence in the two groups: 6/32 (18.8%) for the drained group and 7/34 (20.6%) for the undrained group. The hospital stay was significantly longer for the drained group (mean 10.1 days, median 9 days) versus the undrained group (mean 7.0 days, median 7 days). The power of our study was 0.52; twice our sample size would have been required to achieve a power of 0.80. The evidence suggests that, unless an abscess is present, drainage may be abandoned for children with perforated appendicitis.     

Perforierte Appendixspitze in einer Inguinalhernie als Ursache für einen chronischen Bauchdeckenabsceß

Zusammenfassung. überraschungsbefunde im Zusammenspiel von akuter Appendicitis und Hernien jeder Lokalisation sind au?er in der P?diatrie ein Ph?nomen des alten Patienten und trotz modernster diagnostischer Verfahren immer wieder anzutreffen. Vordringliches Ziel der operativen Behandlung mu? es sein, bei der eigentlichen Appendektomie die meist extraperitoneale Entzündung nicht in den Bauchraum zu transportieren, um die im Alter meist ohnehin in ihrer Abwehr geschw?chten Patienten nicht zus?tzlich zu gef?hrden. Der vorliegende Fall fügt sich nahtlos in diese Reihe ein.