内镜逆行阑尾炎治疗术诊治儿童非复杂性阑尾炎疗效分析  

Therapeutic effect of endoscopic retrograde appendicitis therapy for the diagnosis and treatment of pediatric uncomplicated appendicitis

作　　者：魏绪霞[1] 徐俊杰[1] 吴凡[2] 薛宁[1] Wei Xuxia;Xu Junjie;Wu Fan;Xue Ning(Department of Gastroenterology,Ji′nan Children′s Hospital,Ji′nan 250022,China;Department of Special Inspection,Shandong Academy of Occupational Health and Occupational Medicine,Ji′nan 250002,China)

机构地区：[1]济南市儿童医院消化科,济南250022 [2]山东省职业卫生与职业病防治研究院特检科,济南250002

出　　处：《中华实用儿科临床杂志》2025年第1期27-32,共6页Chinese Journal of Applied Clinical Pediatrics

基　　金：济南市卫生健康委员会科技计划项目(2023-2-134)。

摘　　要：目的对比分析3种不同方式辅助内镜逆行阑尾炎治疗术(ERAT)诊治儿童非复杂性阑尾炎的疗效,探寻最佳ERAT诊疗方式。方法病例系列研究。回顾性分析2019年1月至2023年12月在济南市儿童医院拟诊为非复杂性阑尾炎并行ERAT诊疗的206例患儿临床资料。按不同辅助治疗方式分为X线引导下ERAT(ERAT-X)组13例、B超引导下ERAT(ERAT-B)组109例和洞察镜辅助ERAT(ERAT-DC)组84例。运用ERAT对各组患儿进行阑尾腔探查、腔内冲洗及阑尾粪石取出操作,记录分析患儿阑尾内镜下表现、腹痛改善情况、插管成功率等围手术期资料及术后随访情况。计量资料采用单因素方差分析/Wilcoxon符号秩和检验/Kruskal-Wallis H检验,计数资料采用χ^(2)检验。结果共201例顺利完成插管,分别为ERAT-X组12例,ERAT-B组106例,ERAT-DC组83例。内镜下阑尾黏膜以炎症改变为主要表现。各组患儿治疗前腹痛评分、治疗后腹痛评分、插管成功率、治疗有效率、总体并发症率、抗生素使用率、住院时间比较差异均无统计学意义(均P>0.05)。ERAT-X/ERAT-B/ERAT-DC组治疗后腹痛评分均较治疗前腹痛评分明显降低[0(1.00)分比4(1.50)分/0(1.00)分比4(2.00)分/0(1.00)比4(1.75)分,Z=-3.082、-8.939、-8.009,均P<0.05]。ERAT-DC组诊断率低于ERAT-B组(75.0%比95.4%,P<0.05),ERAT-DC诊断特异性高。ERAT-DC组手术时间较ERAT-X组和ERAT-B组明显减少[38.5(34.3)min比85.0(42.5)min比67.0(27.0)min,Z=80.075、55.865,均P<0.05],住院费用较ERAT-X组和ERAT-B组明显增加[(17269±1035)元比(12081±921)元比(11609±1479)元,Z=-89.308、-104.633,均P<0.05]。随访结果显示,各组患儿(ERAT-X/ERAT-B/ERAT-DC)腹痛复发率(9.1%、16.7%、14.8%)、非计划再手术率(9.1%、10.8%、8.6%)比较差异均无统计学意义(均P>0.05)。结论ERAT是一种安全有效的治疗儿童阑尾炎的方法,EART-DC诊疗儿童阑尾炎精准、可靠,更具优势,值得临床广泛推广应用。ObjectiveTo compare the effects of the endoscopic retrograde appendicitis therapy(ERAT)assisted with 3 different methods in the diagnosis and treatment of children with uncomplicated appendicitis,and to explore the most effective ERAT.MethodsA case series study was made.The clinical data of 206 children with uncomplicated appendicitis who underwent ERAT in Ji′nan Children′s Hospital from January 2019 to December 2023 were retrospectively analyzed.The patients were divided into 3 groups according to the auxiliary treatment method adopted.There were 13 cases receiving X-ray guided ERAT(ERAT-X)group,109 cases receiving B-ultrasound guided ERAT(ERAT-B)group and 84 cases receiving dong cha endoscope guided ERAT(ERAT-DC)group.Appendix cavity exploration,irrigation and fecalith removal were performed by ERAT.Perioperative data such as endoscopic manifestations,abdominal pain and the success rate of intubation and follow-up data were recorded and compared among the three groups of patients.The one-way ANOVA method,Wilcoxon sign rank sum test and Kruskal-Wallis H test were used to analyze measurement data,and theχ^(2) test was used to analyze enumeration data.ResultsA total of 201 cases were successfully intubated,including 12 in the ERAT-X group,106 in the ERAT-B group,and 83 in the ERAT-DC group.The mucosa of the appendix showed different inflammatory changes under the endoscope.There were no significant differences in abdominal pain score before treatment,abdominal pain score after treatment,success rate of intubation,effective rate of treatment,complication rate,antibiotic use rate and length of hospital stay among the three groups(all P>0.05).The abdominal pain score after treatment was significantly lower than that before treatment in all the 3 groups[0(1.00)points vs.4(1.50)points/0(1.00)points vs.4(2.00)points/0(1.00)points vs.4(1.75)points,Z=-3.082,-8.939,-8.009,all P<0.05].The diagnostic rate of the ERAT-DC group was lower than that of the ERAT-B group(75.0%vs.95.4%,P<0.05).The diagnostic specificity of ERA

关 键 词：儿童 非复杂性阑尾炎 内镜逆行阑尾炎治疗术 洞察镜 

分 类 号：R726.5[医药卫生—儿科]