目的

探讨儿童急性阑尾炎术后阑尾粪石残留导致脐部切口感染的临床表现、治疗及预后。

方法

选择2024年5月7日于山东大学附属儿童医院（济南市儿童医院）就诊的1例急性阑尾炎术后阑尾粪石残留致脐部切口感染患儿为研究对象。采用回顾性分析法，收集本例患儿的临床病例资料、主要治疗经过及预后。以“阑尾炎手术”“粪石残留” “阑尾粪石残留” “appendicitis surgery and fecalith residue” “appendiceal fecalith remains”为中、英文关键词，在中国知网、万方数据库、维普中文科技期刊数据库及Pub Med数据库中，检索关于儿童急性阑尾炎术后阑尾粪石残留的相关文献。本次文献检索时间设定为2000年1月1日至2024年7月1日。本研究通过山东大学附属儿童医院（济南市儿童医院）医学伦理委员会的批准（审批文号：SDFE-IRB/T-2024057），并与患儿监护人签署知情同意书。

结果

①患儿为女性，13岁，因转移性右下腹痛3 d入本院，经实验室和影像学检查确诊为急性化脓性阑尾炎，当天进行腹腔镜下阑尾切除术，住院8 d后顺利出院。患儿出院后第2天（术后第10天）脐部切口出现感染伴脓液流出，采取换药处理。于换药第15天，脐部切口自行排出一枚粪石（1.5 cm×1.0 cm）。粪石自行排出后，对患儿继续采取换药治疗，脐部切口7 d后自行愈合。随访2个月结果显示，患儿切口恢复良好，饮食好，无腹部及消化道不适。②根据本研究设定的文献检索策略，检索到相关临床研究文献12篇，加上本例患儿，共计13例儿童阑尾炎术后阑尾粪石残留患儿被纳入文献复习。这13 例患儿中，阑尾炎手术以腹腔镜手术为主（5 例），其次为传统开腹术（4例）；11例出现阑尾粪石残留并发症的时间为术后2 d到4年。其阑尾粪石残留所致并发症中，主要为腹部脓肿（5例）、肝周脓肿（3例）、切口感染（2例）、臀部脓肿（1例）、盲肠瘘（1例）、右髂窝脓肿后迁移至皮下脓肿（1例）。所有患儿预后良好。

结论

儿童急性阑尾炎术后阑尾粪石残留致并发症较少见，以手术治疗为主。儿童急性阑尾炎手术需警惕并避免阑尾粪石残留。

Objective

To investigate the clinical manifestations，treatment，and prognosis of umbilical incision infection caused by r esidual appendicoliths after surgery for acute appendicitis in children.

Methods

A retrospective analysis was conducted on a case of a child with acute purulent appendicitis admitted to Jinan Children's Hospital Affiliated to Shandong University on May 7，2024.Clinical medical records，main treatment processes，and prognosis were collected.Literature related to residual appendicoliths after surgery for acute appendicitis in children was searched in CNKI，Wanfang Database，VIP Chinese Science and Technology Journal Database，and Pub Med using"appendicitis surgery""fecalith residue""appendiceal fecalith residue""appendicitis surgery and fecalith residue"and"appendiceal fecalith remains"as keywords.The literature search was conducted from January 2000 to July 2024.This study was approved by the Medical Ethics Committee of Jinan Children's Hospital Affiliated to Shandong University （Approval No.SDFE-IRB/T-2024057），and informed consent was obtained from the guardian of the child.

Results

①The child was a 13-year-old girl admitted to the hospital with migratory right lower abdominal pain for 3 d.She was diagnosed with acute purulent appendicitis by laboratory and imaging examinations and underwent laparoscopic appendectomy.She was discharged smoothly after 8 d of hospitalization.On the second day after discharge （postoperative day 10），the umbilical incision became infected with purulent discharge，and dressing changes were immediately applied.On the 15th day of dressing changes，a fecalith（1.5 cm×1.0 cm）was spontaneously discharged from the umbilical incision，the child was continued with dressing changes，and the umbilical incision healed spontaneously after 7 d.Follow-up at 2 months showed that the child's incision had recovered well，with good diet and no abdominal or gastrointestinal discomfort.②Literature review results：according to the literature search strategies set by this study，12 relevant clinical researches about postoperative retained appendicoliths for appendicitis were retrieved，and with the child included in this study，a total of 13 children with residual appendicoliths after surgery for appendicitis were included in the literature review.Among these 13 cases，laparoscopic surgery was the main surgical approach（5 cases），followed by traditional open surgery（4 cases）；the time to occurrence of complications due to residual appendicoliths ranged from 2 days to 4 years postoperatively.In addition，the main complications caused by residual appendicoliths were abdominal abscess（5 cases），perihepatic abscess（3 cases），incisional infection（2 cases），gluteal abscess（1 case），cecal fistula（1 case），and migration of a right iliac fossa abscess to a subcutaneous abscess（1 case）.All children had a good prognosis.

Conclusions

Residual appendicoliths after surgery for acute appendicitis in children leading to complications are relatively rare，with surgery being the main treatment.It is necessary to be vigilant and avoid residual appendicoliths during surgery for acute appendicitis in children.