儿童急性阑尾炎若干临床问题20年回顾分析  

Acute appendicitis in children: retrospective analysis of some clinical problems in the past 20 years

作　　者：余世耀[1] 施诚仁[1] 潘伟华[1] 王俊[1] 沈涤华[1] 张弛[1] 王捍平[1] 葛莉[1] 徐长辉 

机构地区：[1]上海第二医科大学附属新华医院小儿外科,200092 [2]枣庄矿业集团公司中心医院外科

出　　处：《中华小儿外科杂志》2004年第2期112-115,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的　急性阑尾炎是儿童外科常见疾病之一 ,本文旨在通过回顾性调查方法 ,对其临床诊断、手术和保守治疗、临床抗生素的应用、影像学检查的评价等作一分析 ,以有助于今后临床工作。方法　对我院小儿外科自 1984年 1月至 2 0 0 2年 12月间因腹痛待查、急性阑尾炎收治的病例进行临床回顾性分析。内容包括流行病学特征 ,病理分型 ,抗生素的应用方案和并发症的处理。结果　我院小儿外科近 2 0年中以腹痛待查、急性阑尾炎收治的患儿总共 5 733例 ,其中男 35 14例 (占 6 1.3% ) ,女2 2 19例 (占 38.7% ) ,结果提示急性阑尾炎发病率无季节性差异。收治病患中共行阑尾切除术 5 0 0 1例 ,阑尾穿孔率 13.9% ,阴性阑尾切除率 2 2 .0 % ;病理分型无季节差异 ,但近 5年来阴性阑尾切除率显著降低 ;阑尾穿孔率无季节差异 ,但是近 5年来阑尾穿孔率显著降低 ;对急性阑尾炎的抗生素应用包括庆大霉素、氨苄青霉素、先锋V号和甲硝唑等 ,术后并发症的发病率为 4 .7% (2 37/ 5 0 0 1例 ) ,其中包括粘连性肠梗阻 ,消化道出血 ,盆腔脓肿等 ;死亡 1例 (0 .0 2 % )。结论　儿童急性阑尾炎的临床处理重在及时的诊断和手术介入 ,对发病时间在 16h以内的疑似患儿应行临床观察 ,必要时作B超鉴别 ,CT由于其射线侵袭性质 ,使用仍需审慎。Objective Acute appendicitis is a common surgical problem in children. We studied the medical records of our patients with acute appendicitis retrospectively with emphasis on the diagnosis, surgical or non-surgical treatment, antibiotics usage and imaging technological intervention so as to facilitate its clinical management in the future. Methods The medical records of the patients with acute appendicitis and suspected acute appendicitis in our center were analyzed. Results During the past 20 years, there were 5?733 children ( 3?514 boys and 2?219 girls) treated as appendicitis or suspected appendicitis in our hospital. There was no difference in the morbidities or pathological types during different seasons. Five thousand and one operations were performed in these patients. Perforation and negative appendectomy rates were 13.95% and 22.0% respectively and both rates had declining trends during the past 5 years. There were 2 antibiotic groups: 1) gentamycin, ampicillin and metranidazole, and 2) cefuroxime and metranidazole. The third generation cephalosporins became popular in these years due to the increasing incidence of resistant bacteria. The complication rate was 4.7% and they included intestinal adhesion, pelvic abscess, and intestinal hemorrhage. Mortality rate was 0.02%. Conclusions Prompt diagnosis and surgical intervention play crucial role in the management of acute appendicitis in children. Close observation and ultrasonography are safe and effective methods of diagnosing appendicitis in most of patients with suspected conditions. As CT exposes children to significant doses of irradiation, it is important to identify other simpler ways which can achieve good diagnostic yield before its acceptance for acute appendicitis in children.

关 键 词：儿童 急性阑尾炎 术后并发症 发病率 病理分型 流行病学 

分 类 号：R726.5[医药卫生—儿科]