小儿腹腔镜下阑尾切除术后30 d内再入院的影响因素分析  

Analysis of Influencing Factors of Readmission within 30 Days after Laparoscopic Resection of Acute Appendicitis in Children

作　　者：廖思祺 季春宜[2] 袁妙贤[2] 尹强[2] LIAO Siqi;JI Chunyi;YUAN Miaoxian(The School of Pediatrics,University of South China,Hengyang Hunan 421000)

机构地区：[1]南华大学儿科学院,湖南衡阳421000 [2]湖南省儿童医院普外一科,湖南长沙410007

出　　处：《医学临床研究》2024年第10期1465-1467,1471,共4页Journal of Clinical Research

基　　金：湖湘高层次人才聚集工程支持计划(2023RC4011);湖南省自然科学基金面上项目(203JJ30329)。

摘　　要：【目的】探讨小儿腹腔镜下阑尾切除术(laparoscopic appendectomy,LA)后30 d内再入院的影响因素。【方法】选取2019年1月至2024年3月在湖南省儿童医院行LA后30 d内再入院的53例急性阑尾炎患儿的临床资料,根据是否再次手术分为再次手术组(n=7)和非再次手术组(n=46)。收集所有患儿年龄、性别、首次入院时急性阑尾炎炎症反应评分(appendicitis inflammatory response score,AIR)、首次病程时间、首次住院时间、病理类型、首次起病至入院时间、再入院前症状持续时间,首次出院和再次入院时白细胞(white blood cell,WBC)计数、中性粒细胞与淋巴细胞比值(neutrophil lymphocyte ratio,NLR)、C-反应蛋白(C-reactive protein,CRP),分析患儿LA后30 d内再入院的相关危险因素。【结果】53例再入院患儿中,诊断为腹腔脓肿22例(43.51%)、肠梗阻19例(35.85%)、肠梗阻合并腹腔脓肿6例(11.32%)、腹腔脓肿合并伤口感染5例(9.43%)、阑尾残株炎1例(1.89%)。再次入院时WBC计数、NLR均高于首次出院时(P<0.05),CRP水平与首次出院时比较,差异无统计学意义(P>0.05)。再手术组和非再手术组再次住院时间比较,差异有统计学意义(P<0.05);两组首次入院时AIR、首次起病至入院时间、首次住院时间及再入院前症状持续时间比较,差异无统计学意义(P>0.05)。53例再入院患儿经治疗皆好转出院。【结论】小儿阑尾炎术后再入院因素主要为腹腔脓肿及肠梗阻,早期干预可降低阑尾炎术后并发症发生率及再入院患儿比例。【Objective】To explore the influential factors affecting readmission within 30 days after laparoscopic appendectomy(LA)in children.【Methods】The clinical data of 53 children with acute appendicitis who were readmitted within 30 days after LA in Hunan Children's Hospital from January 2019 to March 2024 were selected,and they were divided into the reoperation group(n=7)and non-reoperation group(n=46)according to whether they underwent reoperation or not.Age,sex,appendicitis inflammatory response score(AIR)at first admission,duration of first disease,duration of first hospital stay,pathological type,duration from first onset to admission,and duration of symptoms before readmission were collected.White blood cell(WBC)count,neutrophil lymphocyte ratio(NLR),and C-reactive protein(CRP)at first discharge and readmission,and risk factors associated with readmission within 30 days after LA were analyzed.【Results】Among the 53 readmitted children,22 cases(41.51%)were diagnosed with abdominal abscess,19 cases with intestinal obstruction(35.85%),6 cases with intestinal obstruction combined with abdominal abscess(11.32%),5 cases with abdominal abscess combined with wound infection(9.43%),and 1 case with appendicitis(1.89%).At readmission,WBC count and NLR were higher than those at the first discharge(P<0.05),and CRP level was not significantly different from that at the first discharge(P>0.05).The rehospitalization time between the reoperation group and the non-reoperation group was statistically significant(P<0.05).There was no significant difference in AIR at first admission,time from first onset to admission,time of first hospitalization and duration of symptoms before readmission between the two groups(P>0.05).All 53 cases were discharged after treatment.【Conclusion】The main readmission factors of appendicitis in children are abdominal abscess and intestinal obstruction.Early intervention can reduce the incidence of postoperative complications and the proportion of readmission children.

关 键 词：阑尾炎/外科学 急性病 腹腔镜检查 阑尾切除术 影响因素分析 

分 类 号：R726.568[医药卫生—儿科]