Japanese

Title	小児複雑性虫垂炎における治療法の検討 - 治療成績とinterval appendectomy脱落予測因子を踏まえて -
Subtitle	原著
Authors	久松千恵子1,2, 辻恵未1, 畠山理1
Authors (kana)
Organization	1姫路赤十字病院小児外科, 2現:愛仁会高槻病院小児外科
Journal	日本小児外科学会雑誌
Volume	56
Number	4
Page	370-375
Year/Month	2020 / 8
Article	原著
Publisher	日本小児外科学会
Abstract	「要旨」【目的】小児複雑性虫垂炎のより良い治療法を, interval appendectomy(以下IA)脱落予測因子と治療成績を踏まえて検討した. 【方法】対象は2009年1月〜2018年12月に当院で治療した複雑性虫垂炎144例. 緊急手術群と抗生剤加療先行のIA企図群に分け治療前評価項目を比較した. IA企図群をIA成功群, IA脱落群, IA非実施群に細分し, IA成功群とIA脱落群の比較からIA脱落予測因子を抽出した. 治療成績は緊急手術群, IA成功群, IA脱落群の3群間で比較した. 手術は全例腹腔鏡下で行った. 【結果】緊急手術群104例, IA企図群40例(IA成功群25例, IA脱落群9例, IA非実施群6例). IAは, 下痢があり, CRP高値, 大きな膿瘍形成があり, 診断までに日数を要した症例に選択される傾向にあった(全てp<0.01). 糞石有りの症例は緊急手術を選択する傾向にあった(p=0.006). IA企図の場合, IA脱落群はIA成功群に比べ, 年齢が高く, 虫垂は太く, 糞石を認めたが, 膿瘍は小さい傾向だった(全てp<0.04). IA脱落予測因子は糞石有りと膿瘍最大径の2因子で, 特に糞石有り(オッズ比25.06)は重要な因子となった. 治療成績では. 手術時間はIA成功群が, 総入院日数は緊急手術群が有意に短かった(共にp<0.001). 開腹移行はIA脱落群に多かった(p=0.01). 【結論】複雑性虫垂炎の治療成績では, IAは手術時間が短く, 緊急手術は総入院日数が短い利点があった. しかしながら, 糞石有りの症例はIA企図から脱落する可能性が示唆され, 治療法を選択する上で留意が必要である.
Practice	臨床医学：外科系
Keywords	急性虫垂炎, 複雑性虫垂炎, 小児, interval appendectomy, 脱落予測因子, acute appendicitis, complicated appendicitis, children, predictor

English

Title	Appropriate Treatment for Complicated Appendicitis in Children
Subtitle	Originals
Authors	Chieko Hisamatsu1,2, Emi Tsuji1, Tadashi Hatakeyama1
Authors (kana)
Organization	1Department of Pediatric Surgery, Japanese Red Cross Society Himeji Hospital, 2Present address:Department of Pediatric Surgery, Takatsuki General Hospital
Journal	Journal of the Japanese Society of Pediatric Surgeons
Volume	56
Number	4
Page	370-375
Year/Month	2020 / 8
Article	Original article
Publisher	Japanese Society of Pediatric Surgeons
Abstract	Purpose: Although emergent appendectomy (EA) for complicated appendicitis (CA) is straightforward, interval appendectomy (IA) following non-operative management (NOM) is sometimes chosen to treat CA because of exacerbated inflammation. We reviewed our institutional experience of CA cases with a focus on the predictor of NOM failure and the outcome of treatments. Methods: A total of 144 children with CA treated between 2009 and 2018 were retrospectively analyzed. All operations were attempted laparoscopically. Results: EA was performed on 104 children (Group EA). The remaining 40 initially underwent NOM: 25 underwent IA successfully (Group IA-S), 9 had failed NOM (Group IA-F), and 6 never underwent surgery. On comparing the pretreatment evaluation of EA with NOM, NOM tended m be chosen for cases involving diarrhea and those with an elevated CRP level, those with a larger abscess, or those that took longer to diagnose (p<0.01 each). On the other hand, EA tended to be chosen for cases involving fecalith (p=0.006). In the NOM group, the presence of fecalith was likely an independently significant predictor of NOM failure (odds ratio 25.06). On the outcome of treatments, Group IA-S had a significantly shorter duration of surgery, and Group EA had a significantly shorter length of hospitalization (p<0.001 each). Group IA-F had the highest rate of conversion to laparotomy (p=0.01). Conclusions: On the outcome of CA treatments, IA had a shorter operative time, and EA had a shorter length of hospitalization. However, considerable attention to the fact that the presence of fecalith will more likely lead to NOM failure is needed for the treatment decision.
Practice	Clinical surgery
Keywords	acute appendicitis, complicated appendicitis, children, interval appendectomy, predictor

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