1179例小儿穿孔性阑尾炎的临床分析  

Clinical analysis of 1179 cases of perforated appendictis in children

作　　者：顾秀文[1] 金先庆[1] 李晓庆[1] 周德凯[1] 董欣竞[1] 李勤[1] 冯卫[1] 王轲[1] 

机构地区：[1]重庆医科大学附属儿童医院普外科,400014

出　　处：《重庆医学》2010年第17期2357-2358,2361,共3页Chongqing medicine

摘　　要：目的总结分析小儿穿孔性阑尾炎的临床特点及诊治体会,提高对小儿穿孔性阑尾炎的全面认识,以指导临床诊治。方法对1990-2009年6 607例小儿阑尾炎患者详细资料32项临床指标进行统计,并对其中1 179例小儿穿孔性阑尾炎各项资料进行统计分析。结果手术治疗1 179例,平均就诊时间为44.03 h,72 h以上组穿孔率明显高于其他病程组,3岁以下组穿孔率明显高于其他年龄组。临床症状主要表现为腹痛、发热、恶心与呕吐、腹部压痛、血常规白细胞及中性粒细胞比例升高。细菌培养主要是大肠埃希菌。弥漫性腹膜炎患者,术中腹腔冲洗组平均住院时间较未冲洗组短。阑尾穿孔患儿存在术后并发症38例,发生率为3.22%;1例死亡。结论阑尾穿孔多见于学龄期儿童,小年龄患儿的穿孔率较高,早期诊断和及时手术是降低小儿穿孔性阑尾炎发病率的关键。右下腹持续疼痛和右下腹固定压痛是早期临床诊断阑尾炎的充要条件,合理使用抗生素是影响本病预后的重要因素。Objective To summary and analyse the clinical features,diagnosis and treatment of children with perforated appendicitis and to enhance the overall understanding of perforated appendicitis,to guide clinical diagnosis and treatment.Methods To analyse the data of 1179 cases of perforated appendicitis in children on the 1990-2009 period.Results The average visiting time was 44.03h.The perforated rate of 72 h duration were significantly higher than that of other groups,under 3 years were significantly higher than other age groups.The main clinical symptoms were abdominal pain,fever,nausea and vomiting,abdominal tenderness,blood leukocyte count and the proportion of neutrophils increased.The major bacteria was escherichia coli.In cases of diffuse peritonitis,the average hospital stay of peritoneal lavage group was longer than that of non-peritoneal lavage group.38 cases of children with perforated appendicitis existed postoperative complications,the incidence rate was 3.22%,1 died.Conclusion Ruptured appendicitis is more common in children of school age.In children of small age,a higher perforation rate should be alert,early diagnosis and timely surgery are the key to reduce the incidence of perforated appendicitis in children.Continuous pain in right lower quadrant and right lower quadrant fixed tenderness is necessary and sufficient conditions to early clinical diagnosis of appendicitis,the use of antibiotics is an important factor in disease prognosis.

关 键 词：小儿阑尾炎 穿孔 诊断 治疗 临床分析 

分 类 号：R726.5[医药卫生—儿科]