免疫妥协儿童急性阑尾炎的临床特征及诊治探讨  

Clinical features,diagnoses and treatments of acute appendicitis in immunocompromised children

作　　者：陈巍[1,2] 刘璐 刘婷婷[3] 王大勇[3] 张廷冲[1] 陈亚军[1] Chen Wei;Liu Lu;Liu Tingting;Wang Dayong;Zhang Tingchong;Chen Yajun(Department of General Surgery,Affiliated 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、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、首都医科大学附属北京儿童医院急诊外科,北京100045

出　　处：《临床小儿外科杂志》2025年第2期159-164,共6页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨免疫妥协儿童急性阑尾炎的临床特点及治疗策略。方法回顾性分析首都医科大学附属北京儿童医院2007年3月至2020年12月收治的29例罹患急性阑尾炎的免疫妥协儿童临床资料,包括人口学特征、临床表现、实验室及影像学检查、治疗方式及预后。结果29例患儿中,男21例、女8例,年龄4.40(3.05,8.45)岁。主要临床症状为发热(24例,82.8%)、腹痛(24例,82.8%),主要腹部体征为腹部压痛(23例,79.3%)、肌紧张(9例,31.0%)和反跳痛(8例,27.6%)。16例(16/29,55.2%)中性粒细胞减少(中度1例、重度15例)。29例均予多种抗生素联合治疗,18例(18/29,62.1%)使用1种及以上特殊限制级抗生素。10例(10/29,34.5%)初次诊断急性阑尾炎后即予手术治疗,其中7例采用腹腔镜手术、3例采用开腹手术,开腹手术患儿中,2例出现术后切口感染;腹腔镜手术患儿中,1例术后2个月出现肠梗阻,经保守治疗后缓解;19例予保守治疗,除1例因多脏器功能衰竭放弃治疗外,其余18例均治愈出院,其中9例于保守治疗后行择期阑尾切除术,无一例发生围手术期并发症。结论对于免疫妥协的急性阑尾炎患儿,及时经验性联合使用广谱抗生素治疗可以有效控制病情,缓解临床症状;在无绝对手术禁忌证的情况下,明确诊断后行阑尾切除术安全、有效。Objective To explore the clinical characteristics and treatment of acute appendicitis in children with immune compromise.Methods From March 2007 to December 2020,the relevant clinical data were retrospectively reviewed for 29 immunocompromised children of acute appendicitis(AA)hospitalized at Affiliated Beijing Children’s Hospital.Demographic profiles,clinical manifestations,laboratory tests and imaging findings were recorded.Results There were 21 boys and 8 girls with a male-to-female ratio of 2.63∶1.Median age was 4.4(3.05,8.45)year.Major symptoms included fever(n=24,82.8%)and abdominal pain(n=24,82.8%).And major physical signs included abdominal tenderness(n=23,79.3%),muscular rigidity(n=9,31.0%)and rebound tenderness(n=8,27.6%).Sixteen cases(n=16,55.2%)were accompanied by neutropenia(moderate,n=1;severe,n=15).All of them recieved multiple antibiotics.And 18 children(n=18,62.1%)were treated with one or more special restricted antibiotics.Ten children(n=10,34.5%)were operated upon an initial diagnosis of AA.Laparoscopy(n=7)and open surgery(n=3)were performed.Two laparotomic cases developed postoperative incision infection.And one laparoscopic case of intestinal obstruction at Month 2 post-operation was relieved after conservative measures.Nineteen children were treated conservatively.Except for 1 case giving up treatment due to multiple organ failure,18 children were clinically cured and discharged.Nine children underwent elective appendectomy during follow-ups and there were no perioperative complications.Conclusions For immunocompromised AA children,timely empirical co-dosing of broad-spectrum antibiotics is efficacious.If there are no absolute surgical contraindications,early surgery is both safe and effective.

关 键 词：急性阑尾炎 免疫妥协 病理状态 体征和症状 阑尾切除术 保守治疗 治疗结果 儿童 

分 类 号：R726.5[医药卫生—儿科]