儿童复杂性阑尾炎不同治疗方式的临床研究

Different treatment outcomes for children with complicated appendicitis

目的比较不同治疗方式在复杂性阑尾炎患儿中的治疗效果及相关并发症,以期获得较为合理的治疗方案。方法回顾性分析2010年至2015年我科收治的复杂性阑尾炎患儿2198例(非手术治疗组786例,急诊手术组1 412例)。数据统计及评价指标主要包括血WBC总数及CRP值,影像学结果,静脉抗生素使用种类及时间,住院时间,并发症种类及发生率。结果在临床发病特点上,非手术治疗组与急诊手术组无明显差异(P>0.05)。血液检验指标提示,治疗后WBC在非手术治疗组呈逐渐下降趋势(F=34.53,P=0.000),在急诊手术组亦呈逐渐下降趋势(F=11.27,P=0.002),但非手术治疗组下降更快;CRP在非手术治疗组呈逐渐下降趋势(F=23.82,P=0.000),在急诊手术组中呈术后短时间上升,后逐渐下降趋势(F=5.43,P=0.028),在非手术治疗组中下降更快。在两组静脉抗生素使用种类无明显差异的前提下,非手术治疗组静脉抗生素使用时间(7.95±5.02 vs 9.51±4.75;t=3.28,P=0.001)较急诊手术组短,住院时间(8.33±5.38 vs 10.44±6.44;t=3.47,P=0.001)亦为非手术治疗组更短;非手术治疗组的并发症发生率更低(χ~2=41.95,P=0.000),其中肠梗阻、腹腔积液及腹腔包块的发生率均较急诊手术组低。结论儿童复杂性阑尾炎早期非手术治疗的静脉抗生素使用时间、住院时间及并发症的发生率均低于急诊手术治疗,血液检验指标趋势及影像学评估亦优于急诊手术组,提示早期非手术治疗可能为大部分复杂性阑尾炎患儿更为合适的治疗方式。

Objective To compare the outcomes of different treatments for children with complicated ap-pendicitis Methods A retrospective study was conducted for 2198 children of complicated appendicitis from 2010 to 2015.Among them,786 patients received initial non -surgical treatment and another 1412 underwent acute appendectomy.Clinical data were analyzed with regards to counts of white blood cell （WBC）and C—re-active protein （CRP）,imaging outcomes,type and duration of intravenous antibiotics,length of hospital stays and complications. Results Two groups had similar distributions of age,gender,body weight,duration of symptoms and counts of WBC and CRP on admission.After treatment,WBC of two groups showed a trend of gradual decline with non -surgical group going down faster （group A：F =34.53,P =0.000;group B：F =11.27,P =0.002）.CRP of non-surgical group decreased generally （F =23.82,P =0.000）.However,in a-cute appendectomy group,a brief rise was followed by a decline after operation （F =5.43,P =0.028）.Under the precondition of no significant difference between types of intravenous antibiotic,patients of non -surgical treatment had a shorter duration of antibiotics （7.95 ±5.02 vs 9.51 ±4.75;t =3.28,P =0.001）and hospital stays （8.33 ±5.38 vs 10.44 ±6.44;t =3.47,P =0.001）than those undergoing acute appendectomy and also a lower complication rate （χ2 =41.95,P =0.000）,including ileus or bowel obstructions,seroperitoneum and abdominal mass. Conclusions Compared with acute appendectomy,non-surgical treatment of complicated ap-pendicitis offers fewer complications,shorter durations of antibiotics and hospital stays in children.And blood test tendency and radiographic evaluations are superior to emergency treatment.Therefore non -surgical treat-ment may be preferred for most cases.