某医院20年间阴性阑尾切除调查与分析

Analysis on current status and the change of pediatric negative appendectomy rate-20 years experience in a children’s hospital

目的：探讨临床阴性阑尾切除的现状、变迁及影响因素。方法回顾性分析本院1991—2010年所有因诊断急性阑尾炎而接受阑尾切除，术后结合临床和病理诊断明确为阴性阑尾切除的病例资料。①搜集阴性阑尾切除病例基本资料；②按年份分成4组：A 组（1991—1995年）、B 组（1996—2000年）、C 组（2001—2005年）及 D 组（2006—2010年）。分析各组阴性阑尾切除的发生率，并与同期阑尾穿孔率进行比较；③按年龄分成4组：婴幼儿组（1 d 至3岁）、学龄前组（4～7岁）、学龄期组（8～12岁）、青春期组（13～16岁），统计各年龄组患儿阴性阑尾切除率。结果本院20年间共实施阑尾切除术5469例，其中阴性阑尾切除694例，占同期阑尾切除病例的12．7％。阴性阑尾切除病例中，阑尾误切47例（6．77％）；酷似阑尾炎病例647例（93．2％）；阴性阑尾切除率从1991—1995年的14．9％下降至2006—2010年的7．58％，P 值＜0．001，提示阴性阑尾切除率呈稳定下降趋势；阴性阑尾切除最多发生于8～12岁患儿，最少发生于0～3岁患儿；男女比例为1∶0．9。最常见误诊疾病为肠系膜淋巴结炎、上呼吸道感染、胃肠炎、梅克尔憩室、原发性腹膜炎。结论20年间本院阴性阑尾切除率为12．7％，与阑尾穿孔率相同，均呈稳定下降趋势，大多为酷似阑尾炎疾病，误诊病例少见。

Objetive to analyze the change and current status of negative appendectomy rate（NAR） and its affecting factors.Methods A retrospective study on all cases that underwent appendectomy and were pathologically proven to be negative appendectomy（NA）during 1991—2010.1）Collection of patient informa-tion,2）NA cases were divided into 4 groups by year：group A（1991—1995）,group B（1996—2000）,group C（2001—2005）and group D（2006—2010）.NAR of each group were analyzed and compared with perforated appendicitis rate during the same time period.3）NA cases were divided into 4 age groups：infant group（1 day to 3 years old,pre-school group（4 years old to 7 years old）,primary school group（8 years old to 12 years old） and adolescent group（12 years old to 16 years old）,NAR for each group were then analyzed and compared. Results During the years,5 469 cases of appendectomy were performed,including 694 cases of negative ap-pendectomy,which makes a 12.7% of NAR.47 of 694 （6.77%）cases were misdiagnosed and the rest （93.2%）were appendicitis -similar cases.NAR declined from 14.9% （1992—1995）to 7.58% （2006—2010）,suggesting a steady declination of NAR.Negative appendectomy occurred most frequently in the prima-ry school group（8 years old to 12 years old）,least frequent in the infant group.Male to female ratio for nega-tive appendectomy was 1 ∶0.9.Most common misdiagnosed diseases were acute mesenteric lymphadenitis,re-spiratory tract infections,gastroenteritis,Meckel’s diverticulitis and primary peritonitis. Conclusions The Children’s Hospital of Fudan University has a negative appendectomy rate of 12.7% in the past 20 years, which shows a steady decline along with perforated appendicitis rate;negative appendectomy are most frequent in 8 years old to 12 years old patients;difference in male to female ratio is insignificant;most negative appen-dectomy cases are appendicitis-similar cases and misdiagnosed cases are less common.