小児の腫瘤形成性虫垂炎に対する一期的腹腔鏡下虫垂切除

Initial laparoscopic appendectomy for acute appendicitis presenting with an appendiceal mass in children

◆要旨：小児の腫瘤形成性虫垂炎に対しては，一期的虫垂切除または保存的治療後の待機的虫垂切除が行われるが，現在も定まった治療方針はない．筆者らは，小児の腫瘤形成性虫垂炎に対して一期的腹腔鏡下虫垂切除（以下，本法）を行ってきたので，その結果を検討し報告する．2009年1月～2011年12月に本法を施行した15歳以下の腫瘤形成性虫垂炎11例を対象とした．11例全例で本法を完遂し，手術時間は平均157.6分で，術中合併症は認めなかった．術後は平均7.5日目に退院となった．術後合併症として腹腔内遺残膿瘍を1例認めた．小児の腫瘤形成性虫垂炎に対して本法は安全に施行可能で，短期間で治療を完了しえた．

［Background］The management of acute appendicitis presenting with an appendiceal mass in children remains controversial with 2 schools of thought; initial appendectomy vs nonoperative management with interval appendectomy. The aim of this study is to determine the role of initial laparoscopic appendectomy（LA） in children with an appendiceal mass. ［Methods］This is a retrospective study of 11 consecutive pediatric patients who were operated LA for an appendiceal mass in our department from January 2009 to December 2011. ［Results］There were no conversions to an open procedure in all 11 patients. The average operation time was 157.6 minutes. There were no perioperative morbidities. The average length of hospitalization after LA was 7.5 days. Postoperative intraabdominal abscess developed in one patient.［Conclusion］LA for an appendiceal mass can be performed safely in children. It can also shorten the duration of treatment. The outcomes of our case series indicate that initial LA is appropriate, and should be standard method for an appendiceal mass in children.