儿童急性阑尾炎手术后粘连性肠梗阻的相关因素分析

Influencing factors of postoperative adhesive ileus in children with acute appendicitis

目的探讨儿童急性阑尾炎(acute appendicitis,AA)术后发生粘连性肠梗阻(adhesive ileus,AI)的影响因素及相关预防措施。方法收集天津市儿童医院2014年1月至2017年6月行阑尾切除术(acute appendicitis resection,AAR)的168例AA患者为研究对象,按照术后是否发生AI分为梗阻组(n=42)和未梗阻组(n=126),以性别、年龄、病程、阑尾炎类型、是否穿孔、手术方式、手术操作时间、是否留置引流管、术前相关炎症指标(PCT、CRP、白细胞及中性粒细胞)为自变量进行回归分析。结果42例AAR后发生AI的时间与年龄存在相关性(r=0.535,P<0.05),Logistic分析结果显示:病程长(OR=1.071,95%CI:1.040~1.104)、PCT水平升高(OR=1.735,95%CI:1.178~2.555)为AI的危险因素;而年龄较大(OR=0.966,95%CI:0.945~0.987)、男性(OR=0.199,95%CI:0.049~0.802)及采用腹腔镜手术(OR=0.092,95%CI:0.015~0.543)为AI的保护因素。结论AA病程、PCT、年龄、性别及手术方式是AAR后发生粘连性肠梗阻的影响因素,当儿童AA满足手术适应证时,应及早行腹腔镜阑尾切除术;对于年龄较小及术前PCT水平较高的患者,术后应警惕AI发生的可能。

Objective To explore the influencing factors of postoperative adhesive ileus(AI)for children with acute appendicitis and preventive measures.Methods A collection of 168 patients with AA who underwent appendectomy in Tianjin Children's Hospital from January 2014 to June 2017 were the research subjects.According to whether AI will occur after surgery,they were divided into obstruction group(n=42)and non-obstruction group(n=126).Two groups were retrospectively analyzed with regards to gender,age,disease course,type,perforation,surgical approach,operative duration,indwelling drainage tube,preoperative related inflammation parameters,such as procalcitonin(PCT),C-reactive protein(CRP),leucocyte&neutrophil.Multivariate Logistic regression analysis was performed for these factors.Results There was a correlation between onset of postoperative AI and age in 42 cases(r=0.535,P<0.05).Multivariate Logistic analysis indicated that longer disease course(OR=1.071,95%CI:1.040-1.104)and higher PCT(OR=1.735,95%CI:1.178-2.555)were two risk factor of AI while higher age(OR=0.966,95%CI:0.945-0.987),male gender(OR=0.199,95%CI:0.049-0.802)and laparoscopy(OR=0.092,95%CI:0.015-0.543)were protective factors.Conclusion Disease course,PCT,age,gender and surgical approaches are major influencing factors of postoperative AI.When acute appendicitis fulfills the operative indications,pediatric laparoscopic appendectomy should be performed as early as possible.For children with lower age and higher PCT index,postoperative AI should be closely watched.