内镜下逆行治疗儿童早期急性阑尾炎临床评估及疗效分析

Clinical evaluations and efficacy analysis of endoscopic retrograde treatment of early acute appendicitis in children

目的探究内镜下逆行阑尾炎治疗术(endoscopic retrograde appendicitis therapy,ERAT)明确诊断急性阑尾炎及临床疗效的优势性和有效性。方法收集2020年5月至2022年10月四川省人民医院(电子科技大学附属医院)小儿外科急诊收治入院的急性阑尾炎69例患儿的临床资料,依据治疗方案分为两组:ERAT组33例、腹腔镜阑尾切除术治疗(laparoscopic appendectomy,LA)组36例,ERAT组采用内镜下逆行阑尾治疗术,LA组采用腹腔镜阑尾切除术治疗。分析对比ERAT组和LA组基线资料、治疗效果、炎症指标恢复及住院时间住院费用、术后并发症、术后随访情况等。结果ERAT组符合急性阑尾炎表现,临床诊断成功率为100%,技术成功率为96.9%(32/33),临床治疗成功率87.8%(29/33)。与LA组比较,ERAT组术后进食时间早、手术操作时间短、术后腹痛缓解快、住院时间短、住院费用低、白细胞恢复正常时间均低于LA组(P<0.01)。1例ERAT术后随访6个月时复发行腹腔镜阑尾切除术,随访期间复发率为3.45%(1/29)。结论内镜下逆行阑尾炎治疗术在儿童早期急性阑尾炎运用可明显缩短治疗周期,降低术后疼痛程度,术后阑尾炎复发率低,住院时间短且费用低。

Objective To evaluate the benefits and efficacies of endoscopic retrograde appendicitis therapy(ERAT)for acute appendicitis(AA)in children.Methods Retrospective analysis was performed for the relevant clinical data of 69 AA children admitted in an emergency setting from May 2020 to October 2022.According to surgical approaches,they were divided into two groups of ERAT(n=33)and laparoscopic appendectomy(LA,n=36).ERAT group underwent endoscopic retrograde appendiceal irrigation.Baseline profiles,treatment outcomes,recovery of inflammatory parameters,hospitalization expenses,postoperative complications and postoperative follow-ups were compared.Results In ERAT group,33 cases were consistent with AA and success rate of clinical diagnosis was 100%.Appendiceal intubation failed in 1 case and technical success rate of ERAT was 96.9%(32/33).The success rate of ERAT was 87.8%(29/33).As compared with LA group,ERAT group offered the advantages of early postoperative feeding time,shorter operative duration,faster postoperative relief of abdominal pain,shorter hospitalization stay,lower hospitalization expenses and shorter average time of white blood cell recovery(P<0.01).The inter-group differences were statistically significant.One case underwent LA due to recurrence at Month 6 post-ERAT.The recurrence rate was 3.45%(1/29)during follow-ups.Conclusions For early AA in children,ERAT can significantly shorten treatment cycle,avoid negative appendectomy,relieve postoperative pain,lower postoperative recurrence rate of appendicitis,shorten length of stay and lower hospitalization expenses.