伴中性粒细胞缺乏症的恶性肿瘤患儿罹患急性阑尾炎的临床特点及治疗策略  

Clinical features and treatment strategies of acute appendicitis in children with malignant tumors and neutropenia

作　　者：陈巍[1,2] 张廷冲 王大勇[3] 刘婷婷[3] 陈亚军[1] Chen Wei;Zhang Tingchong;Wang Dayong;Liu Tingting;Chen Yajun(Department of General Surgery,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Pediatric Surgery,Beijing Tsinghua Changgung Hospital,Beijing 102218,China;Department of Emergency Surgery,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心(北京),首都医科大学附属北京儿童医院普外科,北京100045 [2]北京清华长庚医院儿外科,北京102218 [3]国家儿童医学中心(北京),首都医科大学附属北京儿童医院急诊外科,北京100045

出　　处：《中华实用儿科临床杂志》2024年第10期766-769,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的:探讨伴中性粒细胞缺乏症的恶性肿瘤患儿罹患急性阑尾炎的临床特点及治疗策略。方法:病例系列报告。回顾性分析首都医科大学附属北京儿童医院2007年3月至2023年10月收治的罹患急性阑尾炎,同时伴中性粒细胞缺乏症的恶性肿瘤患儿的临床资料,包括人口学特征、临床表现、实验室检查及治疗方式。计数资料组间比较采用Fisher′s确切概率检验;计量资料符合正态分布时采用t检验,不符合正态分布时,采用非参数秩和检验。结果:24例患儿纳入研究,年龄4.3(2.9,4.3)岁,男女比例为7︰1。恶性肿瘤以急性淋巴细胞白血病(75%)占比最多。临床表现以发热(92%)、腹痛(75%)为主。6例患儿采用手术治疗(5例腹腔镜手术)(手术治疗组),18例患儿采用保守治疗(保守治疗组)。手术治疗组患儿局限性或弥漫性腹膜炎的体征占比(83%)显著高于保守治疗组(25%)(P=0.007)。手术治疗组患儿阑尾炎症状缓解时间[(1.00±0.00)d]短于保守治疗组[(5.50±3.60)d](t=-4.323,P=0.001)。接受腹腔镜手术患儿的住院时长[6.00(2.00,8.00)d]短于保守治疗组[9.50(6.75,20.50)d](Z=-2.136,P=0.033)。全部患儿急性阑尾炎均治愈,住院期间无死亡病例。结论:对于伴中性粒细胞缺乏症的恶性肿瘤患儿罹患急性阑尾炎,手术治疗和保守治疗均安全有效。手术治疗可以更快的缓解症状,腹腔镜阑尾切除可以缩短住院时长。ObjectiveTo investigate the clinical features and treatment strategies of acute appendicitis in children with malignant tumors and neutropenia.MethodsThis was a case series report.A retrospective review was conducted on the children with malignant tumors complicated by neutropenia,who were admitted to the Beijing Children′s Hospital,Capital Medical University between March 2007 and October 2023 due to acute appendicitis.The clinical data of the patients,including demographic characteristics,clinical manifestations,laboratory tests,and treatment strategies,were collected.The Fisher′s precision probability test was performed for group comparisons of count data.The t-test was performed for normally distributed measurement data,and the non-parametric rank-sum test for non-normally distributed measurement data.ResultsTwenty-four patients were included in the study.The age of the patients was 4.3(2.9,4.3)years,and the male-to-female ratio was 7︰1.Acute lymphoblastic leukemia(75%)was the most common type of malignancy.The main clinical manifestations were fever(92%)and abdominal pain(75%).Six patients underwent surgical treatment(5 laparoscopic surgeries)(the surgical treatment group),and 18 patients received conservative treatment(the conservative treatment group).The proportion of patients with signs of localized or diffuse peritonitis was significantly higher in the surgical treatment group(83%)than in the conservative treatment group(25%)(P=0.007).The symptomatic relief time of acute appendicitis was significantly shorter in the surgical treatment group[(1.00±0.00)days]than in the conservative treatment group[(5.50±3.60)days](t=-4.323,P=0.001).The length of hospital stay was significantly shorter in patients who underwent laparoscopic surgery[6.00(2.00,8.00)days]than in patients who received conservative treatment[9.50(6.75,20.50)days](Z=-2.136,P=0.033).Acute appendicitis was cured in all patients,and there were no deaths during hospitalization.ConclusionsBoth surgical and conservative treatments are safe an

关 键 词：儿童 中性粒细胞缺乏症 急性阑尾炎 恶性肿瘤 腹腔镜阑尾切除术 

分 类 号：R726.5[医药卫生—儿科] R730.5[医药卫生—临床医学]