小儿阑尾炎腹腔镜治疗的分析

目的 重点探讨小儿阑尾炎腹腔镜治疗的并发症发生情况及防治措施。方法 小儿阑尾炎１００例,男６７例,女３３例,年龄４￣１４岁,单纯性阑尾炎６例,化脓性６４例,坏疽穿孔性３０例,全部病例采取紧闭式气管内麻醉,造成人工气腹,使用电视腹腔镜,以内或电凝及套扎方法完成阑尾切除术。结果 术中阑尾动脉出血１例,腹膜前气肿１例,大网膜气囊肿１例,术后腹腔内感染２例,脐部穿刺孔疝１例,均经相应处理。１００例中有９８     

腹腔镜治疗小儿复杂性阑尾炎的临床分析

目的 对比分析腹腔镜阑尾切除术(LA)和开腹阑尾切除术(OA)治疗小儿复杂性阑尾炎的疗效.方法 回顾性分析2004年5月至2010年12月收治的小儿复杂性阑尾炎1008例的临床资料,比较LA组和OA组手术时间、住院费用、腹腔脓肿及切口感染发生率.结果 两组均无手术死亡病例.LA组有24例中转开腹手术,Trocar孔/切口感染发生率(6.1％)较OA组(11.9％)低,差异有统计学意义(P=0.001).术后腹腔脓肿发生率LA组较OA组高(7.4％vs 3.7％),差异有统计学意义(P=0.011).LA组手术时间较OA组长[(54±12)min vs (53±14)min],且费用较OA组高[(7305±426)元vs (7255±435)元],但差异均无统计学意义(P=0.226,P=0.066).结论 LA具有创伤小、恢复快、并发症少、住院时间短等优点,是治疗小儿复杂性阑尾炎安全、有效的手术方式,但术后腹腔脓肿发生率偏高.     

小儿急性阑尾炎的腹腔镜手术治疗

随着腔镜外科技术的发展,急性阑尾炎也成为腹腔镜手术的适应证。但由于小儿大网膜发育不成熟,病史不典型,病情进展快,阑尾壁薄,阑尾易发生坏疽、穿孔,风险较高,如何选择手术方式是临床上亟待关注的课题。作者总结了2005年1月至2010年11月收治的14岁以下急性阑尾炎患儿中60例腹腔镜手术治疗病例资料,现报告如下。     

超声引导下内镜逆行性阑尾炎治疗术在儿童非复杂性阑尾炎中的应用

目的:研究超声引导下内镜逆行性阑尾炎治疗术对儿童非复杂性阑尾炎的应用价值。方法:本研究为单中心、回顾性研究,纳入2018年10月至2020年10月在空军军医大学第二附属医院儿科住院临床诊断为阑尾炎并行超声引导下内镜逆行性阑尾炎治疗术的患儿,分析患儿的临床特点、疗效及预后情况。结果:共纳入152例患儿的电子病例数据,男7...     

小儿急性阑尾炎199例诊治体会

小儿急性阑尾炎发病率居小儿急腹症首位。本院1992年1月至2007年12月共手术治疗急性阑尾炎689例，其中12岁以下的小儿199例，占阑尾炎总数的28．88％。现报告如下。     

腹腔镜手术与开腹手术治疗儿童复杂性阑尾炎的疗效比较

目的对比分析腹腔镜阑尾切除术（1apamscopicappendectomy,LA）与开腹阑尾切除术（openappendectomy,OA）治疗儿童复杂阑尾炎的临床疗效。方法回顾性分析本院自2014年6月至2015年2月收治的45例儿童复杂阑尾炎患者临床资料,根据不同手术方式分为LA组和OA组,其中LA组21例,OA组24例,比较两组术中出血量、手术时间、术后肠功能恢复时间及住院时间、切口感染、腹腔脓肿及直肠刺激症状的发生率及留置腹腔引流的比率等。结果本组45例均痊愈。LA组手术时间（88．6±20．1）min,OA组手术时间（84．1±10．2）min,两组差异无统计学意义（P=0．340）。LA组有2例中转开腹手术。LA组术中出血（14±10．2）mL,术后肠功能恢复时间（32．6±12．3）h,住院时间（4．2±1．9）d,Troear孔感染率（4．8％）,直肠刺激症状发生率（9．5％）,置腹腔引流率（19．0％）,腹腔脓肿发生率（9．5％）。OA组术中出血（26±9．2）mL,术后肠功能恢复时间（50．6±19．2）h,住院时间（6．2±1．8）d,切口感染率（33．3％）,直肠刺激症状发生率（37．5％）,置腹腔引流率（75％）,腹腔脓肿发生率（37．5％）。两组上述指标比较,差异均有统计学意义（P值分别为：0．000,0．001,0．001,0．044,0．029,0．000,0．029。所有患儿术后随访4～12个月,无一例发生阑尾残株炎、肠瘘及粘连性肠梗阻等并发症。结论腹腔镜手术治疗儿童复杂阑尾炎,安全有效,术后并发症少,有利于患儿术后康复。     

小儿急性阑尾炎的临床及诊治进展

急性阑尾炎是小儿腹部外科常见疾病,传统影像学检查对小儿急性阑尾炎的诊断较困难,同时大多数儿童典型症状出现的时间较晚,导致明确诊断的时间延长,往往容易导致各种并发症,包括阑尾穿孔、脓肿形成、腹膜炎和败血症等,使其病死率大大增加。因此,本文旨在回顾小儿急性阑尾炎的临床诊治进展,以期更好地指导临床医生对小儿急性阑尾炎的诊疗工作。     

儿童急性坏疽性阑尾炎544例病原学变迁与治疗

目的回顾性分析儿童急性坏疽性阑尾炎的病原学变迁,探讨合理使用抗生素的方法。方法2003年1月至2007年12月本院收治急性坏疽性阑尾炎患儿544例,将2003年1月至2005年6月的168例设为Ⅰ组,2005年7月至2007年2月376例设为Ⅱ组,分析两组病原学特点及抗生素的使用与疗效。结果两组腹腔内脓液培养及药敏试验率为85．5％（465／544）,总细菌培养阳性率为72％（335／465）,其中Ⅰ组为84．7％（116／137）,Ⅱ组为68．6％（219／319）。Ⅱ组革兰氏阳性球菌的阳性检出率明显增加,而革兰阴性杆菌的检出率明显减少。结论儿童急性坏疽性阑尾炎脓培养阳性率降低,革兰氏阳性球菌所占比例逐渐明显升高,临床应合理选用抗生素,以达到更好的疗效。     

小儿阑尾炎早期诊断的临床研究——30年10256例小儿阑尾炎经验总结

目的总结连续30年10256例小儿阑尾炎的诊断治疗经验,提出早期诊断的临床标准,为早期手术治疗提供依据,以降低病死率,减少并发症。方法统计1980年至2009年本院收治的小儿阑尾炎病例10256例,使用32项临床指标进行对比研究,提出核心诊断指标指导临床早期诊治。在新的理念指导下,分析前10年及后20年,阑尾炎病例在腹膜炎的发生率以及阑尾炎病理类型上的变化,探讨早期诊断标准在提高阑尾炎诊治水平方面的实际意义。结果10256例阑尾炎病例中,死亡1例,死亡率小于1／10000。8241例阑尾炎病例的有效统计中,持续性右下腹疼痛或伴哭吵不安症状的患儿8131例（98．67％）,右下腹固定压痛8103例（98．33％）。实施早期诊断标准后,阑尾炎穿孔形成腹膜炎的发生率从早期的43．82％降低为29．88％。10256例中,595例为婴幼儿阑尾炎,466例并发阑尾周围脓肿。结论持续性右下腹疼痛及右下腹固定压痛是临床诊断小儿阑尾炎的核心指标,既是必要的,也是充分的。小儿阑尾炎的临床早期诊断是提高治愈率,减少并发症的关键。     

Laparoscopic appendectomy is recommended for the treatment of complicated appendicitis in children

Laparoscopic appendectomy in children is well accepted for the treatment of non complicated appendicitis. An increased risk of postoperative intraabdominal abcess formation has been reported in complicated appendicitis. The puropose of this study was to compare open (OA) versus laparoscopic appendectomies (LA) in complicated appendicitis in children and to assess the safety and feasibility of LA. The hospital records of 118 consecutive patients who underwent appendectomy for complicated appendicitis (perforated/gangrenous) from 2000 to 2006 were retrospectively analysed. Fifty-four patients had LA and 64 underwent OA. There were 74 males and 44 females. The length of hospital stay ranged from 4 to 12 days in the LA group and 4 to 17 days in the OA group. Five patients (9.2%) in the LA group had post operative complications; intraabdominal collections in 3 and wound infections in 2. Ten patients (15.6%) had postoperative complications in the OA group; intraabdominal collections in 5, wound infection in 3, pleural effusion in 1 and prolonged ileus in 1. In complicated appendicitis the complication rate is lower for LA as compared to OA. We recommend laparoscopic approach to all children presenting with complicated appendicitis.     

小儿急性阑尾炎的诊断与鉴别诊断

小儿急性阑尾炎是小儿外科最常见的急腹症之一,早期正确诊断是合理治疗必要的前提,但是目前诊断与鉴别诊断仍然存在许多问题.充分了解小儿急性阑尾炎的临床特点及需要鉴别诊断的内外科疾病,通过典型临床症状、仔细的体格检查、实验室及影像学检查综合评估,能够正确诊断该病,必要时可以采用腹腔镜检查明确诊断.     

The role of imaging in children with suspected appendicitis: the UK perspective

The diagnosis of uncomplicated acute appendicitis is often straightforward, allowing timely appendicectomy without the need for expensive tests or imaging. Repeated clinical examination by an experienced surgeon has traditionally been the key to making the diagnosis in both straightforward and difficult cases. Nonetheless, all surgeons will remove some normal appendices. Sometimes it can be particularly difficult to make the diagnosis, especially in the child under 5 years of age, in teenage girls, in young women and in the elderly. When difficult to make, the diagnosis may be significantly delayed and since the pathology is progressive, the patient may suffer potentially avoidable complications. This paper looks at two potential roles for imaging. Firstly, can imaging, applied selectively, help make the difficult diagnosis less difficult and so reduce delays and morbidity? Secondly, could imaging all patients with suspected appendicitis reduce the number of normal appendices removed from children who seem to have all the signs and symptoms of straightforward uncomplicated acute appendicitis but who actually have presumed self-resolving non-appendiceal pathology? The answer to these questions may depend on three factors that are not entirely independent: a surgical unit’s current audited negative appendicectomy rate, population base/case mix and the expertise of the examining surgeon. Individual surgeons and some surgical units, by policy, use modern imaging techniques with quite different frequencies that may be appropriate depending on these three factors. This article argues that a careful history and repeated clinical examination is the key to making the diagnosis, with imaging, primarily ultrasonography, being used in patients with a palpable mass or in those having had 48 h of hospital observation without progress. In Europe, imaging has played a limited role in the investigation of the child with suspected appendicitis with the diagnosis relying on repeated examination by an experienced clinician. Ongoing changes in surgical training in the UK may affect the acquisition of clinical expertise that is crucial to this clinical management. High-quality surgical training and surgical audit are needed to monitor the delivery of care and to ensure that the care pathway being used is appropriate for the local resources and population.     

儿童恶性血液病并发急性阑尾炎的处理及结果

目的探讨和总结小儿恶性血液病并发急性阑尾炎的治疗及手术时机。方法回顾分析19例小儿恶性血液病并发急性阑尾炎的临床资料,骨髓抑制、血像的特征、病情危急程度,选择治疗方法。结果19例并发阑尾炎患儿紧急手术切除7例;12例保守治疗,经积极抗生素,全身支持疗法,体温逐渐正常,腹痛缓解,腹部体症消失,B超检查恢复正常。结论小儿恶性血液病由于化疗,骨髓抑制并发阑尾炎是一个非常严重的并发症,处理不及时会造成严重后果,而手术时机的选择又非常关键,我们认为只有在紧急状况下(明显腹痛刺激症、肠梗阻等)可选择急诊手术。对那些恶性血液病伴阑尾多次发作或有包块形成者,待原发病稳定后也需作手术治疗,对于符合保守治疗条件者,一旦诊断明确,必须马上积极治疗,消除病灶。     

Harmonic US imaging of appendicitis in children

Background Harmonic imaging (HI), a relatively new ultrasound modality, was initially reported to be of use only in obese adult patients. HI increases the contrast and spatial resolution resulting in artefact-free images, and has been shown in adults to significantly improve abdominal sonography. Regarding its application in paediatric patients, just a handful reports exist and these do not encompass its use in intestinal sonography. Objective To compare the sonomorphological image quality of HI and fundamental imaging (FI, conventional grey-scale imaging) in the diagnosis of histologically confirmed appendicitis in children. Materials and methods For this prospective comparative study, 50 children (male/female 25/25; mean age 9.9 years) suspected of having appendicitis were recruited. In all patients US examination of the appendix and periappendiceal region was performed preoperatively and appendectomy carried out. The final diagnosis was based on histological examination of the appendix. Both FI and HI were used in the US examination (tissue harmonic imaging, THI; Sonoline Elegra, Siemens; 7.5 MHz linear transducer). A detailed comparison of the images from FI and HI was performed using a scoring system. The parameters compared included delineation of the appendiceal contour, wall, mucosa, contents of the appendix and surrounding tissues. Furthermore, periappendiceal findings such as mesenteric echogenicity, free fluid, lymph nodes and adjacent bowel wall thickening were compared. Results In 43 children (86%) acute appendicitis was histologically confirmed. The inflamed appendix could be depicted in the HI and FI modes in 93% and 86%, respectively. HI was found to be significantly better for the depiction of the outer contour, wall, mucosa and contents of the appendix (P<0.01). This was also true for the demonstration of free fluid, mesenteric lymph nodes, adjacent bowel walls and mesenteric echogenicity. Conclusion HI should be the preferred modality for scanning the right lower abdomen in suspected acute appendicitis. The diagnosis of acute appendicitis can then be more definitely ascertained.     

Antibiotic therapy in pediatric acute appendicitis: Compliance with local protocol to reduce antibiotic overuse

PurposeAcute appendicitis is one of the commonest surgical emergencies in pediatrics. Treatment usually consists of a combination of surgery and antibiotics. The present study was designed to assess compliance with our local antibiotic protocol and analyse the consequences of non-compliance.MethodsChildren presenting with acute appendicitis between 2015 and 2017 were included in this study. The diagnosis of acute appendicitis was confirmed during surgery. Data concerning the antibiotic therapy received and infectious complications were reviewed.ResultsA total of 142 children with acute appendicitis were included. Antibiotic therapy complied with the protocol in 27.4% of cases, while an excessive duration of antibiotic therapy was observed in 65% of cases. A total of 270 days of non-recommended antibiotic therapy was noted; 32% of patients received a non-recommended combination of antibiotics. The infectious complications rate was 12.8% in the group of patients receiving appropriate antibiotic therapy, and 11.6% in the group with non-compliance to the protocol. No statistically significant difference between the groups was found (P = 0.85).ConclusionPoor compliance with the antibiotic guidelines for appendicitis resulted in antibiotic overuse with no benefit in terms of anti-infective efficacy. Better information for the medical team and repeated evaluation of our practices are essential.     

小儿急性阑尾炎的诊治体会

目的 探讨儿童急性阑尾炎的诊治特点。方法 回顾1998年6月～2003年6月期间四川大学华西医院收治的940例小儿急性阑尾炎临床资料，总结其临床特点及处理经验。结果 本组940例，发热、腹痛、右下腹固定压痛及白细胞升高为最主要表现，939例经手术及病理检查证实诊断，术后均痊愈，其中18例有白血病、血液系统疾病及其他原发疾病的患儿，确诊后也经手术治疗痊愈。另1例有原发白血病的患儿经内科治疗缓解后离院，预后不详。结论 发热、腹痛、右下腹固定压痛及白细胞升高仍是诊断小儿急性阑尾炎的最主要依据，并且小儿阑尾炎一经诊断应尽早处理，年龄越小，越应积极手术。对合并其他原发疾病的阑尾炎患儿，在充分准备的情况下仍可进行外科治疗，以防严重并发症发生。     

Imaging of acute appendicitis in children: EU versus U.S. ... or US versus CT? A European perspective

There is substantial evidence that imaging may reduce the negative appendectomy rate, also in children. However, controversy exists about the preferred method: US or CT, and the choice appears to be determined by the side of the Atlantic Ocean. This review brings forth several arguments in favour of US.     

Perforated appendicitis in children: to drain or not to drain?

We studied 66 children with perforated appendicitis at the University of New Mexico to determine whether or not transperitoneal drainage has any advantage in the management of these children. Patients were assigned to one or the other treatment group on the basis of the call schedule of the attending surgeons, two of whom preferred drainage and two of whom did not. Other aspects of appendicitis management (e. g., supportive care, antibiotics) were the same for both groups. Thirty-two other children who had an abscess at the time of appendectomy were excluded from the analysis. The two study groups were similar in age and severity of illness. Postoperative complications (wound infection, abdominal abscess, small-bowel obstruction) had a similar incidence in the two groups: 6/32 (18.8%) for the drained group and 7/34 (20.6%) for the undrained group. The hospital stay was significantly longer for the drained group (mean 10.1 days, median 9 days) versus the undrained group (mean 7.0 days, median 7 days). The power of our study was 0.52; twice our sample size would have been required to achieve a power of 0.80. The evidence suggests that, unless an abscess is present, drainage may be abandoned for children with perforated appendicitis.