新生儿阑尾炎19例临床分析

Clinical manifestations of 19 neonatal appendicitis cases

目的总结分析新生儿阑尾炎患儿的临床表现、诊断方式、治疗方式及预后特点。方法回顾性分析2019年1月至2022年12月西安交通大学附属西安市儿童医院收治的19例新生儿阑尾炎患儿(阑尾炎组)的临床资料,并对比同期收治的38例新生儿败血症患儿(败血症组),分析两组临床表现、影像学、治疗方法及预后的特点。结果19例阑尾炎患儿中,6例(31.6%)为早产儿,平均出生体重为(2927.9±796.2)g,男∶女=2.17∶1。19例阑尾炎患儿的首发症状为腹胀(8/19,42.1%)、发热(8/19,42.1%)。而败血症组患儿的首发症状主要是发热(20/38,52.6%)、精神反应改变(7/38,18.4%)。阑尾炎组中,出现腹胀(89.5%比5.3%)、呕吐(36.8%比2.6%)、拒乳纳差(84.2%比39.5%)、精神反应改变(94.7%比71.1%)及腹部阳性体征(84.2%比5.3%)等表现的患儿所占比例较败血症组显著增高(P均<0.05)。16例(84.2%)阑尾炎患儿的C-反应蛋白(CRP)升高,14例(73.7%)患儿在治疗过程中监测CRP较起病时升高。与败血症组相比,阑尾炎组患儿治疗过程中CRP峰值更高(P<0.05)。阑尾炎组中,15例(78.9%)患儿仅超声提示阑尾炎,主要表现为右腹低回声区或液性暗区、阑尾壁增厚或腔内积液、阑尾周边液性渗出等;3例(15.8%)患儿超声及CT均提示阑尾炎;1例患儿经手术诊断。8例(42.1%)新生儿阑尾炎并发阑尾穿孔。15例(78.9%)阑尾炎患儿经内科保守治疗,4例(21.1%)经手术治疗,均治愈出院,且电话随访无复发或穿孔。结论新生儿有发热,或不明原因败血症,尤其是合并腹部症状或体征,治疗过程中CRP不降反升,应尽早完善腹部超声检查,必要时CT检查或手术探查,以明确新生儿阑尾炎诊断,并尽早治疗。

Objective To study the clinical characteristics,diagnosis,treatment and prognosis of neonatal appendicitis.Methods From January 2019 to December 2022,19 neonates with appendicitis(appendicitis group)and 38 neonates with sepsis(sepsis group)admitted to the Neonatal Department of Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University were studied.The characteristics of clinical manifestation,imaging,treatment and prognosis of neonates in two groups were analyzed,retrospectively.Results Among 19 neonates with appendicitis,31.6%were premature,the mean birth weight was(2927.9±796.2)g,male∶female=2.17∶1.Abdominal distention(8/19,42.1%)and fever(8/19,42.1%)were the first symptoms of appendicitis,and the first symptoms of sepsis were mainly fever(20/38,52.6%)and poor reaction(7/38,18.4%).In the appendicitis group,the proportions of abdominal distension(89.5%vs.5.3%),vomiting(36.8%vs.2.6%),breast resistance(84.2%vs.39.5%),mental reaction changing(94.7%vs.71.1%)and abdominal positive signs(84.2%vs.5.3%)were significantly higher than those in sepsis group(P<0.05).C-reactive protein(CRP)was elevated in 16 neonates with appendicitis and 13 neonates with sepsis,and elevated gradually in 14 neonates with appendicitis.Compared with sepsis group,CRP was higher in appendicitis group(P<0.05).Fifteen(78.9%)neonates with appendicitis were diagnosed only by ultrasound,mainly manifested as low echo area or liquid dark area in the right abdomen,thickening of the appendix wall or effusion in the cavity,and liquid exudation.Three(15.8%)neonates with appendicitis were diagnosed by ultrasound and CT.Eight(42.1%)neonates with appendicitis were complicated appendiceal perforation.Fifteen neonates with appendicitis were treated by conservative treatment,four cases were treated by operation,and all of them were cured and discharged.Conclusion Abdominal ultrasonography should be improved as soon as possible in neonates with fever and septicemia,especially those with abdominal symptoms or signs,or CRP increased during treatment,and CT or surgical exploration if necessary,to confirm the diagnosis of neonatal appenditis and early treatment.