68例小儿慢性阑尾炎的临床特点和治疗体会

Clinical characteristics and treatment experience of 68 children with chronicappendicitis

目的总结小儿慢性阑尾炎的临床特点,探讨其诊断方法及腹腔镜手术治疗的临床应用价值。方法回顾性分析安徽医科大学第一附属医院2015年1月至2020年1月期间收治的68例慢性阑尾炎患儿的临床资料及治疗过程,总结分析其临床特点和治疗经验。结果根据病史和症状不同,68例患儿分为了3组,症状典型组15例,阑尾脓肿组28例,无典型症状组25例;无典型症状组25例患儿均进行了钡剂灌肠检查,其中68.0%(17/25)的患儿阑尾腔内可见充盈缺损,16.0%(4/25)的患儿未见明显阑尾显影,68.0%(17/25)的患儿72 h后阑尾管腔仍有钡剂残留。3组患儿发病均集中在学龄期,但3组间在不同年龄段的患儿占比差异无统计学意义(P>0.05);全部病例均行腹腔镜探查术,66例顺利完成腹腔镜阑尾切除术,2例中转开腹手术,术后均恢复满意,术后并发症发生情况3组间比较差异无统计学意义(P>0.05)。结论小儿慢性阑尾炎临床表现多样,不易诊断,症状不典型患儿钡剂灌肠检查(含72 h后复查)可帮助明确诊断;小儿慢性阑尾炎好发于学龄期儿童,腹腔镜探查+阑尾切除术为首选治疗方法。

Objective To summarizes the clinical characteristics of chronic appendicitis in children and discusses the diagnostic methods and the clinical application value of laparoscopic surgery.Methods The clinical data and treatment process of 68 children with chronic appendicitis admitted to the First Affiliated Hospital of Anhui Medical University from January 2015 to January 2020 were retrospectively analyzed,and their clinical characteristics and treatment experience were summarized and analyzed.Results According to different medical histories and symptoms,68 cases were divided into 3 groups,with 15 patients in the typical symptom group,28 patients in the appendix abscess group,and 25 patients in the asymptomatic group.All the 25 children in the asymptomatic group underwent barium enema examination,among which 68.0%(17/25)had filling defect in the appendix cavity,16.0%(4/25)had no obvious appendix visualization,and 68.0%(17/25)had residual barium in the appendix cavity after 72 hours.The incidence of children in the 3 groups was concentrated at school age,but there was no significant difference in the proportion of children in different age groups between the three groups(P>0.05).All cases underwent laparoscopic exploration,66 cases successfully completed laparoscopic appendectomy,2 cases transferred to laparotomy,and all recovered satisfactorily.There was no statistically significant difference in the incidence of postoperative complications between the 3 groups(P>0.05).Conclusions The clinical manifestations of chronic appendicitis in children are diverse and difficult to diagnose.Barium enema examination(including re-examination after 72 hours)in children with atypical symptoms can help confirm the diagnosis.Chronic appendicitis in children is more common in school-age children,and laparoscopic exploration+appendectomy are the preferred treatment.