婴幼儿急性阑尾炎临床特点分析

Clinical features and etiological analysis of acute appendicitis in infants

目的总结106例婴幼儿阑尾炎的临床资料,阐述其临床特点。方法回顾性分析本院普外科2012年1月至2013年11月收治的106例婴幼儿阑尾炎的临床资料,总结其主要临床表现发生率、辅助检查阳性率、病原学资料及诊治经验。结果 1本组患儿平均年龄2岁4个月,男性多于女性(2.31∶1)。2临床表现除持续性腹痛(84.91%)和发热(90.56%)外,呕吐(69.81%)、腹泻(32.08%)等胃肠道症状发生率高且突出,查体有腹部固定压痛(95.28%),同时伴肌紧张(84.91%)、反跳痛(79.25%)的腹膜炎体征发生率高。3本组病例中腹部超声检查阳性发现率为90.29%,外周血血常规白细胞升高占79.25%。4术后病理结果以化脓性(46.23%)及坏疽性(50.94%)阑尾炎为主,阑尾穿孔率为56.60%。经统计学分析,不同病程中各种病理类型阑尾炎发生率差异无统计学意义(P=0.544);不同病程中阑尾炎阑尾穿孔率差异无统计学意义(P=0.966)。5本组脓培养阳性率为91.75%,前3位细菌分别是大肠埃希菌(66.04%)、铜绿假单胞菌(9.43%)和咽峡炎链球菌(8.49%)。6本组病例均经手术治疗,治愈率为100%,术后并发症发生率为9.43%。结论婴幼儿阑尾炎的临床表现不典型,病情进展快,穿孔率高,易出现各种并发症。

Objective To summarize the clinical features of acute appendicitis in infants,and to provide a reference for improving the early diagnosis and treatment of acute appendicitis in infants.Methods The medical records of 106 infants with acute appendicitis between January 2012 to November 2013 were reviewed.Data including the rates of main clinical features,the positive rates of assistant examination,and the diagnosis,treatment and etiological information were analyzed and summarized,with Chi-square test or K-W test.Results（ 1） The mean age of the infants was 2 years and 4 months,and the ratio of male to female was2.31∶ 1.（ 2） The incidence rates of vomiting（ 69.81%） and diarrhea（ 32.08%） were high and prominent,besides those of persistent abdominal pain（ 84.91%） and fever（ 90.56%）.The fixed tenderness（ 95.28 %）was the common sign of the infants,as well as the high incidence of peritonitis muscle tension（ 84.91%） and rebound tenderness（ 79.25%）.（ 3） The positive detection rate of abdominal ultrasonography was 90.29%.Increased peripheral blood leukocytes accounted for 79.25%.（ 4） The main pathological findings were purulent appendicitis（ 46.23%） and gangrenous appendicitis（ 50.94%）.The appendiceal perforation rate was 56.60%.There were no significant differences of the incidence among various pathological types of appendicitis in different courses（ P = 0.544）.There were no significant differences of the perforation rate in different courses（ P = 0.966）.（ 5） The pus culture positive rate was 91.75%,with the first three pathogenic bacteria Escherichia coli（ 66.04%）,Pseudomonas aeruginosa（ 9.43%）,and Streptococcus anginosus（ 8.49%）.（6） The cure rate was 100% after operation and the complication rate was 9.43%.Conclusion There are no specific clinical manifestations and auxiliary examinations in infants with appendicitis.The rates of perforations and complications are still high.Early diagnosis,timely surgery and the use of antibiotics are the keys to increase the cure rates and reduce complications.