5岁及以下儿童急性阑尾炎——单中心12年回顾性分析  

Acute appendicitis in ≤ 5-year-old children:a 12-year retrospective single-center analysis

作　　者：冯伟 赵旭峰 李苗苗[2] 崔华雷[2] Feng Wei;Zhao Xufeng;Li Miaomiao;Cui Hualei(Graduate School,Tianjin Medical University;Department of Minimally Invasive Surgery,Tianjin Children's Hospital)

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市儿童医院微创外科,天津300134

出　　处：《重庆医科大学学报》2021年第3期341-345,共5页Journal of Chongqing Medical University

基　　金：天津市科委资助项目(编号:14RCGFSY00150)。

摘　　要：目的:回顾性分析5岁及以下儿童急性阑尾炎(acute appendicitis,AA)的临床特点及阑尾切除后的临床结局。方法:收集5岁及以下AA患儿(538例)临床资料,根据术中所见及病理结果将其分为复杂性阑尾炎(complex appendicitis,CA)组(326例)和单纯性阑尾炎(simple appendicitis,SA)组(212例),对比分析2组临床资料。结果:(1)CA组患儿中位数年龄(3.4岁vs 4.3岁,P=0.000)低于SA组,而入院体温(38.4℃vs. 38.1℃,P=0.000)、病程时间(26 h vs. 24 h,P=0.000)高于SA组,CA组呕吐、腹泻、反跳痛及腹胀等症状发生率高于SA组(均P=0.000)。(2)CA组术前白细胞计数、中性粒细胞计数、淋巴细胞计数及降钙素原水平高于SA组(均P<0.05),其中白细胞计数对CA预测效能较高,ROC曲线下面积为0.738(95%CI=0.695~0.781)。(3)CA组住院时间、抗生素使用时间及术中出血量高于SA组,术后并发症发生率均高于SA组(均P<0.05)。结论:5岁及以下儿童AA的临床表现不典型,CA与SA患儿的临床表现、化验指标及临床结局具有一定差异。Objective:To retrospectively analyze the clinical characteristics of acute appendicitis(AA)and outcomes after appendectomy in ≤ 5-year-old children. Methods:The clinical data of 538 children with AA aged five years or younger were collected retrospectively. According to the intraoperative findings and postoperative pathological examination,they were divided into complex appendicitis(CA)group(n=326)and simple appendicitis(SA)group(n=212). Clinical data of the two groups were compared and analyzed. Results:(1) The median age of children in CA group was lower than that in SA group(3.4 years old vs. 4.3 years old,P =0.000),while the admission temperature(38.4 ℃ vs. 38.1 ℃,P=0.000)and symptom duration(26 h vs. 24 h,P=0.000)in CA group were higher than those in SA group,and the incidences of vomiting,diarrhea,rebound tenderness and abdominal distension in CA group were higher than those in SA group(all P<0.05).(2)The levels of white blood cell count,neutrophil count,lymphocyte count and procalcitonin level in CA group were higher than those in SA group before operation(P<0.05). In addition,white blood cell count was more effective in predicting CA,and the area under the ROC curve was 0.738(95%CI=0.695-0.781).(3)The hospitalization time and postoperative antibiotic use time in CA group were longer and the intraoperative blood loss of children in CA group were greater than those in SA group(all P<0.05). Conclusion:The clinical manifestations of AA in children aged five years or younger are not typical.There were some differences in clinical manifestations,assay indicators and clinical outcomes between CA and SA children.

关 键 词：急性阑尾炎 临床特点 回顾性分析 

分 类 号：R726.5[医药卫生—儿科]