新生儿阑尾炎临床特点分析

Clinical manifestations analysis of neonatal appendicitis

目的回顾性分析新生儿阑尾炎的临床特点、诊治方法,减少误诊、误治的发生。方法收集郑州大学第三附属医院2007年1月至2017年8月新生儿阑尾炎患儿临床资料共12例,分析其临床表现、辅助检查、诊治及预后。结果新生儿阑尾炎患儿中早产儿6例,足月儿6例;男9例,女3例。首发症状以反应差(9例)、腹胀(9例)、发热(7例)、纳差(7例)、呕吐(6例)为主。12例患儿血白细胞计数升高,且均有中性粒细胞比例及C反应蛋白升高。10例行腹水培养,7例呈阳性,其中大肠埃希菌3例,肺炎克雷伯菌2例,屎肠球菌2例。影像学以腹部立位片及彩色多普勒超声为临床常用检查。8例行剖腹探查确诊,3例经腹部彩色多普勒超声确诊,1例经腹部CT确诊。手术治疗11例,保守治疗1例,术中发现阑尾穿孔8例;10例术中送病理检查,结果以急性化脓性阑尾炎多见。治愈9例,死亡3例。出院患儿随访失访1例,余8例无术后并发症及其他消化系统合并症。结论新生儿阑尾炎患儿早期症状不典型且穿孔率、死亡率高,临床医生应提高对该病的认识以减少误诊、误治。

Objective To retrospectively analyze the clinical characteristics, diagnosis and treatment of appendicitis in newborns, so as to reduce the occurrence of misdiagnosis and mistreatment. Methods The clinical data of 12 neonates with appendicitis from January 2007 to August 2017 in the Third Affiliated Hospital of Zhengzhou University were collected. The clinical manifestations, laboratory and imageological examination, diagnosis, treatment and prognosis of them were analyzed. Results Among the neonates with appendicitis, there were 6 premature infants, 6 full-term infants, 9 males and 3 females. The main initial symptoms included listlessness (9 cases), abdominal distension (9 cases), fever (7 cases), anorexia (7 cases) and vomiting (6 cases). All the twelve neonates had increased C reactive protein and proportion of neutrophils in varying degrees, and the leukocyte count was mainly increased. Performed peritoneal effusion cultivation was performed in 10 cases, which was negative in 3 cases and positive in 7 cases, including 3 cases of Escherichia coli, 2 cases of Klebsiella pneumoniae and 2 cases of Enterococcus faecium. Abdominal vertical X-ray and abdominal color Doppler ultrasonography were usually selected in abdominal imageological examination for clinical examination. Three were 8 cases proved by laparotomy, 3 cases proved by abdominal color Doppler ultrasonography and 1 case proved by abdominal computed tomography (CT). Eleven cases were treated by surgery and 1 case was treated by conservative treatment, including 8 cases of appendiceal perforation found in surgery. Pathological examination was performed in 10 cases druing operation, and the results showed that acute suppurative appendicitis was predominant. Finally, 9 cases were cured and 3 cases died. No postoperative complication or complications of digestive system was found in follow-up studies of 8 cases cured neonates, and 1 case lost to follow up. Conclusions The early clinical symptoms of neonatal appendicitis are not typical and it often leads to the high perforation rate and high mortality. Clinicians should improve the understanding of neonatal appendicitis to reduce the incidence of misdiagnosis and mistreatment.