儿童肛周脓肿的临床特征及复发相关危险因素分析  

Clinical characteristics and risk factors for recurrence of perianal abscess in children

作　　者：秦凌云[1] 张敬 于志丹 李小芹 王跃生 Qin Lingyun;Zhang Jing;Yu Zhidan;Li Xiaoqin;Wang Yuesheng(Gastroenterology Department of Children's Hospital Affiliated to Zhengzhou University,Henan Children's Hospital,Zhengzhou Children's Hospital,Zhengzhou 450018,China)

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院郑州儿童医院消化内科,450018

出　　处：《中国小儿急救医学》2025年第3期176-180,共5页Chinese Pediatric Emergency Medicine

基　　金：国家自然科学基金(81903330)。

摘　　要：目的探讨儿童肛周脓肿的临床特征及复发危险因素。方法回顾性分析郑州大学附属儿童医院2015年1月至2022年12月住院的161例肛周脓肿患儿的临床资料,依据治疗后是否复发,分为复发组58例和单纯组103例,分析儿童肛周脓肿的临床表现和实验室检查指标及复发危险因素。结果161例肛周脓肿患儿治疗有效率为64.0%(103/161),有58例发生再次脓肿或瘘管形成。病变方位主要为截石位3点方向62例(38.5%)和9点方向67例(41.6%)。61例(37.9%)患儿肛周脓肿引流液细菌培养阳性,病原体为肺炎克雷伯菌48例、金黄色葡萄球菌7例、大肠埃希菌6例。复发组患儿合并的基础疾病主要包括克罗恩病38例、慢性腹泻15例、免疫缺陷5例;而单纯组患儿合并的基础疾病包括克罗恩病3例、慢性腹泻36例、免疫缺陷2例,62例患儿无基础疾病。复发组在性别(χ^(2)=4.347,P=0.041)、年龄(χ^(2)=4.071,P=0.045)、脓肿大小(χ^(2)=6.298,P=0.008)、脓肿合并瘘管(χ^(2)=10.928,P<0.001)、合并基础病(χ^(2)=10.673,P<0.001)、发热(χ^(2)=6.215,P=0.014)、生长发育迟缓(χ^(2)=8.273,P=0.004)、营养不良(χ^(2)=4.521,P=0.038)、住院费用(t=5.581,P=0.021)、住院时间(t=5.309,P=0.036)与单纯组比较,差异均有统计学意义。复发组在白细胞(t=6.873,P=0.006)、C-反应蛋白(t=7.631,P=0.003)、粪钙卫蛋白(t=10.073,P<0.001)、白蛋白(t=4.587,P=0.025)、白细胞介素-6(t=11.648,P<0.001)、肿瘤坏死因子-α(t=7.803,P=0.021)、淋巴细胞计数(t=8.478,P=0.011)、CD4^(+)/CD8^(+)比值(t=10.674,P<0.001)、IgA(t=6.437,P=0.002)与单纯组比较,差异有统计学意义。多因素Logistic回归分析显示,脓肿合并瘘管、克罗恩病及低IgA、低CD4^(+)/CD8^(+)比值、高粪钙卫蛋白为儿童肛周脓肿复发的高危因素。结论儿童肛周脓肿复发率高,易形成肛瘘。儿童肛周脓肿合并瘘管、克罗恩病和低IgA、低CD4^(+)/CD8^(+)比值、高粪钙卫蛋白为儿童肛周脓肿Objective To investigate the clinical characteristics and risk factors for recurrence of perianal abscess in children.Methods A retrospective study was conducted on the clinical data of 161 children with perianal abscess who were hospitalized in the Children's Hospital affiliated to Zhengzhou University from January 2015 to December 2022.Based on whether or not recurrence occurred after treatment,the patients were divided into the recurrence group(58 cases)and the simple group(103 cases).The clinical manifestations,laboratory examination indexes,and recurrence risk factors of children with perianal abscess were analyzed.Results The effective rate of treatment for 161 children with perianal abscess was 64.0%(103/161),and 58 cases had recurrent abscess or fistula formation.The main orientations of the lesions were at the 3 o'clock position in 62 cases(38.5%)and at the 9 o'clock position in 67 cases(41.6%)in the lithotomy site.Bacterial culture of drainage fluid from perianal abscesses was positive in 61(37.9%)children and the pathogens were Klebsiella pneumoniae in 48 cases,Staphylococcus aureus in 7 cases and Escherichia coli in 6 cases.The recurrence group mainly had underlying diseases including 38 cases of Crohn's disease,15 cases of chronic diarrhoea,and 5 cases of immunodeficiency,while the simple group had 3 cases of Crohn's disease,36 cases of chronic diarrhoea,and 2 cases of immunodeficiency,with 62 cases(60.1%)had no underlying diseases.The recurrence group showed significant statistical differences in gender(χ^(2)=4.347,P=0.041),age(χ^(2)=4.071,P=0.045),abscess size(χ^(2)=6.298,P=0.008),abscess with fistula(χ^(2)=10.928,P<0.001),combined with underlying diseases(χ^(2)=10.673,P<0.001),fever(χ^(2)=6.215,P=0.014),growth retardation(χ^(2)=8.273,P=0.004),malnutrition(χ^(2)=4.521,P=0.038),hospitalization cost(t=5.581,P=0.021),and hospital stay(t=5.309,P=0.036)compared to the simple group.Additionally,the recurrence group showed significant statistical differences in white blood cells(t=6.873,P=0.006),C

关 键 词：肛周脓肿 复发 危险因素 儿童 

分 类 号：R726.5[医药卫生—儿科]