32例儿童内镜下逆行阑尾炎治疗术后再外科手术切除阑尾病例分析

Analysis of 32 cases of appendectomy after endoscopic retrograde appendicitis therapy in children

目的探讨儿童内镜下逆行阑尾炎治疗术(ERAT)后再外科手术切除阑尾的相关风险因素。方法分析2019年9月至2023年11月山东大学附属儿童医院行ERAT后再外科手术切除阑尾患儿病例资料,收集患儿一般情况、主要临床表现,根据ERAT效果、按照转外科治疗原因和时间分为住院期间转外科组和阑尾炎复发组,收集ERAT及再外科手术过程情况、术后阑尾病理类型等指标,总结临床经验。结果242例行ERAT患儿中32例再外科手术切除阑尾,男19例,女13例,平均年龄(9.16±2.77)岁,再手术率13.2%。32例患儿主要临床表现为腹痛(32例,100.0%),右下腹痛为主(28例,87.5%),病程持续时间多在3个月以内(30例,93.8%),ERAT术前腹部彩超或CT主要提示阑尾炎(11例,34.4%)、阑尾炎合并阑尾粪石(11例,34.4%)。住院期间转外科组患儿9例,其中5例ERAT插管失败转至外科,4例插管成功但出现阑尾穿孔或阑尾周围脓肿转至外科;术后病理急性化脓性阑尾炎5例,急性坏疽性阑尾炎4例。阑尾炎复发组患儿23例,ERAT术后腹痛均减轻或缓解,但出院后症状反复,经临床评估诊断为阑尾炎复发,行外科手术切除阑尾;多为ERAT术后6个月内再手术(21例,91.3%);术后病理以慢性阑尾炎为主(10例,43.5%)。结论儿童急性化脓性阑尾炎、急性坏疽性阑尾炎ERAT中易出现插管或进镜失败,存在较高转外科手术风险。ERAT治疗儿童慢性阑尾炎可减轻症状,如症状反复,最终仍需外科手术切除阑尾。

ObjectiveTo investigate the related risk factors of surgical appendectomy after endoscopic retrograde appendicitis therapy(ERAT)in children.MethodsFrom September 2019 to November 2023 at the Children's Hospital Affiliated to Shandong University,the data from all related children with appendectomy after ERAT were analyzed.The general situation and main clinical manifestations of the children were collected.According to the effect of ERAT,the patients were divided into transfer to surgical group and appendicitis recurrence group by the reasons and time of transfer to surgical treatment.The indexes such as ERAT and reoperation process and pathological types of appendix after operation were collected,and the clinical experience was summarized.ResultsAmong the 242 children who underwent ERAT,32 cases underwent appendectomy again,including 19 males and 13 females,with an average age of(9.16±2.77)years,and the reoperation rate was 13.2%.The clinical manifestation was abdominal pain(32 cases,100.0%),mainly right lower abdominal pain(28 cases,87.5%),and the main duration was less than 3 months(30 cases,93.8%).Abdominal ultrasound or CT before ERAT mainly indicated appendicitis(11 cases,34.4%)and appendicitis complicated with appendiceal calculus(11 cases,34.4%).There were 9 children in transferred to surgical group,of which 5 cases were transferred to surgery because of ERAT intubation failure,and 4 cases were transferred to surgery because of appendix perforation or abscess.Postoperative pathology showed acute suppurative appendicitis in 5 cases and acute gangrenous appendicitis in 4 cases.There were 23 children in appendicitis recurrence group,whose abdominal pain was relieved after ERAT,but their symptoms were repeated after discharge.After clinical evaluation,they were diagnosed as recurrent appendicitis and underwent surgical appendectomy.Most of them were reoperated within 6 months after ERAT(21 cases,91.3%).Postoperative pathology was mainly chronic appendicitis(10 cases,43.5%).ConclusionAcute suppurative appendicitis and acute gangrenous appendicitis are prone to catheterization or endoscopic failure during ERAT,and there is a high risk of surgical transfer.ERAT may relieve the symptoms of chronic appendicitis in children.If the symptoms are repeated,surgery is still needed to remove the appendix.