手术切除治疗小儿急性阑尾炎的安全性及可行性分析

Safety and feasibility study of appendectomy in children with acute appendicitis

目的：探讨小儿急性阑尾炎行手术切除的时机、疗效及安全性。方法我院2007年9月~2013年9月间收治的急性阑尾炎患儿126例，对其临床资料进行分析总结。按照手术时间分为A组（3d内手术）73例，B组（4~7d手术）34例、C组（8d及以上手术）19例。结果126例患儿中行单纯阑尾切除术者92例，其中行腹腔镜手术者73例，行开腹手术者19例，行阑尾切除加腹腔引流者34例，其中行腹腔镜手术者20例，行开腹手术者14例；A组和B组患儿手术时间、肠道恢复时间及住院时间均短于C组（tAC=2.967，P=0.0387；tBC=2.637，P=0.0459）；A组患儿并发症发生率5.48%（4/73），B组患儿并发症发生率14.71%，C组患儿并发症发生率42.11%（8/19），A组及B组患儿术后并发症发生率明显低于C组患儿（x2AC=4.369，P=0.0252；x2BC=3.697，P=0.0351）；术后C组患儿CRP、IL-6及TNF-α水平均明显高于A组和B组患儿（tAC=3.098，P=0.0395；tBC=2.581，P=0.0439）。结论小儿急性阑尾炎确诊后应及时行手术治疗，早期手术治疗效果更佳，腹腔镜手术用于小儿急性阑尾炎中同样安全有效，但对手术操作技术有一定要求，临床应综合考虑患儿病情、手术条件等确定具体的手术方案，以减少手术损伤。

Objective To investigate the operation timing, efficacy and safety of appendectomy in children with acute appendicitis. Methods Clinical data of 126 children with acute appendicitis admitted in our hospital from September 2011 to September 2013 was retrospectively analyzed.According to operative time, all the cases were divided into group A with 73 cases （no more than 3 days）,group B with 34 cases （4 to 7 days）,and group C with 19 cases（beyond 8 days）. Results Among 126 patients,92 patients received appendectomy,including 73 cases of laparoscopic appendectomy and 19 cases of open appendectomy.34 patients received peritoneal drainage and appendectomy, including 20 cases of laparoscopic appendectomy and 14 cases of open appendectomy.The operation time,recovery time of bowel function and hospital stay in group A and B were shorter than those in group C （tAC=2.967,P=0.0387;tBC=2.637,P=0.0459）.The complication rates in group A,B and C were 5.48% （4/73）,14.71% and 42.11% （8/19） respectively.The complication rate after operation in group A and B was significantly lower than that in group C （x2AC=4.369,P=0.0252;x2BC=3.697,P=0 .0351）.The CRP, IL-6 and TNF-αlevels in group C were significantly higher than those in group A and B（tAC=3.098, P=0.0395;tBC=2.581,P=0.0439）. Conclusion Once children are diagnosed with acute appendicitis, prompt operation should be performed with a better outcome. Laparoscopic appendectomy is also an effective and safe method in treating children with acute appendicitis,but it has higher requirement for the surgical techniques.Proper surgical method should be performed considering the patients＇condition and operation condition to minimize the surgical trauma.