儿童不典型的进展期阑尾炎临床研究

目的探讨儿童不典型进展期阑尾炎的临床特点。方法回顾性的调查2002年1月-2004年8月415例进展期阑尾炎，根据改良Alvarado评分把患儿分成不典型组、疑似组、典型组三组，比较各组之间的临床特点，总结不典型的进展期阑尾炎的临床特点。结果不典型组与典型组患儿之间在年龄分布、肥胖的有无、阑尾位置分布之间有一定的差异性。不典型组4岁以下儿童比例相对较高；肥胖的患儿比例相对较高；它们在阑尾位置分布上是有差别的，典型组以回肠前和盆位为主，而不典型组以盲肠后以及回肠后为主。结论儿童进展期阑尾炎的不典型表现与患儿的低龄、肥胖及阑尾位置有关，单纯使用建立在临床症状基础上的评分系统，可能会延误这些患儿的治疗。

Clinical study of atypical advanced appendicitis in children

Objective To investigate the clinical features of atypical advanced appendicitis in children.Methods The data of 415 patients with acute advanced appendicitis which was identified by pathological examination in Shanghai Xinhua Hospital were retrospectively analyzed. These patients were divided into three subgroups: typical, suspected, and atypical group based on the modified Alvarado score system. The difference of clinical features of these three groups was analyzed.Results Compared to the typical and suspected groups, the atypical group had more patients less than 4 years old and more patients with obesity. Moreover, the appendix of atypical patients more likely located behind the ileum or the caecum.Conclusions Simply using the modified Alvarado score system may lead to the misdiagnosis of the atypical advanced appendicitis in that these patients have lower age, obesity and abnormal position of the appendix.