在腹腔镜尾切除术后,对于儿童复杂的急性尾炎,是否需要腹腔疏通?
Mohamed Ali Shehata1, Wael Abosena, Rami Mohamed Salama
1Pediatric Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
International journal of surgery (London, England)
|December 5, 2025
概括
对于儿童复杂尾炎的腹腔镜尾切除术后的腹腔管疏通并没有减少整体手术部位感染. 然而,二次发现表明潜在的好处,如更少的腹部内感染和更快的恢复,需要进一步研究.
科学领域:
- 儿科手术 儿科手术
- 手术感染 手术感染
- 最少侵入性的手术
背景情况:
- 在儿童中复杂的急性尾炎往往需要手术干预.
- 在复杂尾炎的腹腔镜尾切除术后,腹腔管排水的作用仍在争论中.
- 评估排水效率对于优化儿科手术结果至关重要.
研究的目的:
- 评估腹膜疏通与腹腔镜尾切除术后没有疏通在患有复杂尾炎的儿科患者的有效性.
- 为了确定排水对手术部位感染和其他术后并发症的影响.
主要方法:
- 一项前性随机优势试验,涉及210名患有复杂尾炎的儿童 (≤18岁).
- 在腹腔镜尾切除术 (1:1比率) 后,患者被分配给腹腔管排水 (A组) 或没有排水 (B组).
- 主要结局是整体手术部位感染 (SSI);次要结局包括腹内感染 (IAI),腹膜,恢复时间和医院费用.
主要成果:
- 整体手术部位感染 (SSI) 率在排水和不排水组之间没有显著差异 (20.0%对27.6%;p=0.312).
- 探索性分析表明,排水与较低的腹内感染 (IAI) 率 (6.67%与15.24%相比; p=0.046),手术后阴茎减少,以及更快的肠功能恢复 (中位数13.9h与17.3h相比; p<0.001).
- 二次结果还表明,抗生素持续时间缩短,住院时间缩短,排水30天成本降低,尽管这些需要进一步调查.
结论:
- 腹腔疏通并没有显著降低儿科腹腔镜尾切除复杂尾炎的整体手术部位感染.
- 探索性发现表明排水的潜在好处,包括减少腹腔内感染和改善恢复,以及较低的短期成本.
- 进一步的大规模多中心儿科试验是必要的,以证实这些探索性发现,并指导选择性或常规排水的决定.
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