新生儿急性化脓性阑尾炎并穿孔6例临床分析  

Clinical analysis of 6 cases of acute neonatal suppurative appendicitis with perforation

作　　者：杨航 白强[1] 李传新 颜剑宏 陈莉[1] 肖晗 Yang Hang;Bai Qiang;Li Chuanxin;Yan Jianhong;Chen Li;Xiao Han(Department of General Surgery,Kunming Children's Hospital,Kunming 650228,China)

机构地区：[1]昆明市儿童医院普外科,昆明650228

出　　处：《中华新生儿科杂志（中英文）》2024年第2期80-83,共4页Chinese Journal of Neonatology

基　　金：昆明市卫生健康委员会卫生科技课题项目(2022-04-01-004)。

摘　　要：目的探讨新生儿阑尾炎的临床特点及预后。方法回顾性分析2014年1月至2022年12月昆明市儿童医院普外科行手术治疗的新生儿阑尾炎患儿的临床资料。结果共纳入6例,男1例,女5例,胎龄36~40周,出生体重1990~3300 g,入院日龄5~11 d,起病至入院时间0.5~4 d,均以腹胀为主要表现,合并呕吐4例,发热3例,便血1例,其中5例术前腹部X线片提示消化道穿孔。6例均行手术治疗,术中均确诊阑尾炎伴穿孔,均行阑尾切除术,无死亡病例。1例合并Amyand疝,术中同时行疝囊高位结扎术;1例并发脑膜炎,抗感染3周好转出院;1例术后3个月形成粘连性肠梗阻再次行肠粘连松解术;1例术后1个月形成结肠狭窄,切除狭窄段结肠行一期肠吻合。结论新生儿阑尾炎进展快,诊断困难,术前腹部X线片提示气腹应考虑阑尾炎合并穿孔可能。术中需注意阑尾穿孔与其他病灶的关系,处理相关病灶,必要时改变手术方式,改善患儿预后。Objective To study the clinical features and risk factors of prognosis of neonatal appendicitis.Methods From January 2014 to December 2022,all infants with neonatal appendicitis and received surgery in our hospital were retrospectively analyzed.Results A total of 6 cases were enrolled,including 1 boy and 5 girls,with gestational age 36-40 weeks,birth weight 1990~3300 g,age of admission 5-11 d and time from illness onset to admission 0.5-4 d.All infants had abdominal distension,combined with vomiting in 4 cases,fever in 3 cases and blood in stool in 1 case.Gastrointestinal perforation was found on preoperative abdominal X-ray in 5 cases.All 6 cases received surgery and confirmed the diagnosis of appendicitis with perforation during the surgery.Appendectomy was performed without mortality.1 case had Amyand hernia and received high ligation of the hernia sac during operation.1 case had meningitis and was cured after 3 weeks of antibiotic treatment.1 case developed adhesive intestinal obstruction 3 months after surgery and underwent intestinal adhesiolysis.One case developed colonic stenosis one month after surgery.The stenotic segment of the colon was resected and primary intestinal anastomosis was performed.Conclusions Neonatal appendicitis progresses rapidly and is difficult to diagnose.The possibility of appendicitis with perforation should be considered when preoperative abdominal X-ray suggesting pneumoperitoneum.Intraoperatively,it is necessary to pay attention to the relationship between appendiceal perforation and other lesions for comprehensive treatment,and change the surgical approach accordingly.

关 键 词：阑尾炎 新生儿 消化道穿孔 肠狭窄 

分 类 号：R726.5[医药卫生—儿科]