新生儿阑尾炎临床及超声图像特点分析

Clinical and ultrasonic features of neonatal appendicitis

目的总结新生儿阑尾的临床及超声图像特点。方法选取2007年1月至2017年10月在首都医科大学附属北京儿童医院经手术或临床诊断的新生儿阑尾炎28例,总结其临床及超声图像特点。结果28例新生儿阑尾炎患儿中超声可显示阑尾9例,其中3例阑尾外径<0.4 cm,6例阑尾外径≥0.4 cm;2例阑尾壁厚<0.2 cm,7例阑尾壁厚≥0.2 cm。19例新生儿阑尾显示困难,则重点观察阑尾周围改变。超声扫查提示:28例右下腹可见阑尾周围系膜肿胀,26例可见阑尾周围积脓或炎性包块;超声提示诊断新生儿阑尾炎22例,新生儿坏死性小肠结肠炎4例,消化道穿孔1例;1例因腹胀明显,初诊超声无异常发现,腹胀缓解后超声诊断新生儿阑尾炎。28例患儿中2例继发近端小肠粘连梗阻,2例阴囊内混浊积液。超声随访观察28例新生儿治疗后改变,其中保守治疗21例,18例1个月内超声复查可见周围炎症范围较上次检查缩小(4例5~10个月复发,2例再次手术,2例保守治疗后均好转)。7例手术治疗的患儿中,4例术后1周行超声复查,原病变区局部仅可见少许粘连。结论新生儿阑尾炎临床症状多样,超声图像表现为阑尾周围系膜肿胀,阑尾外径增大(≥0.4 cm)和(或)阑尾壁增厚(≥0.2 cm),可合并积脓和(或)炎性包块,超声检查可对患儿的诊断及治疗提供依据。

Objective To summarize the clinical and ultrasonographic features of neonatal appendicitis. Methods There were twenty-eight neonatal patients who were diagnosed as neonatal appendicitis by clinical and surgical findings in Beijing Children's Hospital, Capital Medical University, from January 2007 to October 2017. The characteristics of clinical and ultrasonographic features were summarized. Results Among twenty-eight cases of neonatal appendicitis, appendix could be identified on ultrasonography in nine cases, including three cases with outer diameter less than 0.4 cm and six cases greater than 0.4 cm. And in two cases the wall of appendix was thinner than 0.2 cm, while it was thicker than 0.2 cm in seven cases. Although appendix was not identified in some cases, there were abnormal findings around the anatomical site of appendix. Ultrasonography showed that periappendicural mesentery was swelled in all twenty-eight cases and periappendicural abscess was present in twenty-six cases. Twenty-two cases of neonatal appendicitis were correctly diagnosed by ultrasonography. For the other 6 cases, four cases were necrotizing enterocolitis, one case was gaslrointestinal perforation, and one case was normal with merely abdominal distension. Among the twenty-eight cases, two cases were adhesive ileus, and two cases were complicated hydrocele of testes. On follow-up, twenty-one cases were treated conservatively, and their inflammation were controlled effectively within a month (in four cases relapsed in 5-10 months, two cases underwent another surgery while the other two cases improved after conservative treatments). Among the seven cases with surgical treatment, ultrasonography follow-up in four cases find only mild adhesion one week after surgery. Conclusions The clinical symptoms of appendicitis in neonates are highly varied. Ultrasound could identify some abnormal findings including periappendiceal mesangial swelling, enlargement of appendiceal outer diameter (≥0.4 cm), thickening of appendiceal wall (≥0.2 cm), and pyogenic/inflammatory mass. Ultrasonography can provide valuable evidences for the diagnosis and treatment in neonatal appendicitis.