ABSTRACT
Objective To analyze the prevention value of endoscopic retrograde appendicitis treatment (ERAT) for postoperative infection of patients with appendicitis. Methods A total of 71 patients with acute appendicitis were selected and divided into two groups, 35 patients in the observation group were treated with ERAT, and 36 patients of the control group underwent laparoscopic appendectomy.The operation indicators, postoperative adverse events, pain scores, and levels of serum inflammatory factors were compared between the two groups. Results The observation group got a longer operation time, less bleeding, shorter in-bed and hospital stay, and lower hospital cost ( all P＜0. 05). The main postoperative adverse event was recurrence in the observation group and infection in the control group, and the total adverse event rate was no significantly different between the two groups ( P＞0. 05). Twelve hours after treatment, the pain score of the observation group was lower than that of the control group ( P＜0. 05). The post-operational serum levers of hypersensitivity C reactive protein, interleukin 1β, interleukin 6, and tumor necrosis factor α decreased in both groups, while the serum levers of interleukin 4 and interleukin 10 increased, especially in the observation group ( all P＜0. 05). Conclusion ERAT is more conducive to balance serum inflammatory factors and stabilize immune function compared with laparoscopic appendectomy, which can effectively prevent postoperative infection.
ABSTRACT
Objetivo:O plastrão apendicular representa 6% dos casos de apendicite aguda e seu tratamento é controverso. O objetivo do presente estudo foi avaliar os resultados obtidos com o tratamento conservador do plastrão apendicular, instituído a partir de fevereiro de 1992. Método: Foram avaliados 36 pacientes com diagnóstico clínico, laboratorial e ultrassonográfico de plastrão apendicular atendidos no Serviço de Cirurgia Geral do Hospital Universitário da Universidade de Brasília no período de 1992 a 2001. Os pacientes eram submetidos a tratamento com antibióticos e observação clínica da remissão dos sintomas. Resultados: Otratamento conservador foi efetivo em 33 pacientes (92%), com remissão dos sintomas e do tumor palpável, bem como da leucocitose. Após período médio de 11,5 semanas, os pacientes foram submetidos à apendicectomia eletiva e quatro pacientes apresentaram infecção superficial de sítio cirúrgico. A análisehistopatológica revelou persistência do quadro agudo em sete pacientes (21%). Conclusão: O tratamento conservador do plastrão apendicular, seguido de apendicectomia eletiva mostrou-se efetivo na maioria dos pacientes, evitando as complicações graves da abordagem cirúrgica precoce.
Background: Accute appendicitis is one of the most common causes of acute abdominal emergency. In 6% of these patients, appendiceal mass is palpable. The management of appendicitis with a palpable mass is controvertial. The present study analyses the results of conservative management of appendiceal mass in patients admitted at the University Hospital of Brasilia between 1992 and 2001. Methods: Thirty-six patients with clinical, laboratorial and sonography findings of appendiceal mass were evaluated andunderwent conservative management based on therapy with intravenous antibiotics and close observation of appendiceal mass reduction. Results: The conservative management was successful in 33 patients (93%). Three patients failed to respond and underwent appendectomy. Elective appendectomy was performed after 11.5 weeks, with a complication rate of 12%. Histopathologic analysis showed persistent acute appendicitis in seven patients (21%). Conclusions: Conservative management of appendiceal mass followed by interval appendectomy seems to be safe and effective.