小儿阑尾炎3例误诊分析

急性阑尾炎是小儿最常见的急腹症，由于小儿生理、病理、解剖方面的特点，误诊率较成人为高。我院儿科自2005年10月～2007年2月因误诊收住儿科后转外科手术确诊为阑尾炎的病例3例。现谈谈自身的心得体会。[第一段]     

小儿急性阑尾炎误诊原因分析

急性阑尾炎是小儿最常见的急腹症,以５一１２岁为多见。由于小儿生理、病理、解剖方面的特点,误诊率较成人为高,本报道我院儿科自１９８４年４月至２００１年１２月因误诊收住儿科后转外科手术确诊为急性阑尾炎的病例５０例。     

小儿阑尾炎21例误诊原因分析

阑尾炎是小儿急腹症主要疾病之一熏由于小儿自身的生理特点及小儿阑尾炎状不典型熏大约1/3的患儿被误诊而导致阑尾穿孔、脓肿形成、腹膜炎、败血症及肠梗阻等熏并使患儿失去早期手术的机会熏影响切口愈合甚至造成死亡眼1演。本文回顾分析21例阑尾炎的误诊原因,现报告如下。1临床资料与结果1.1一般资料本组21例,男12例,女9例;年龄2～14岁,其中<6岁3例,6～14岁18例。发病至就诊时间3h～5d,平均19±4.5h,其中发病至入院时间超过72h的有5例。1.2临床表现20例出现腹痛,其中为上腹或脐周疼痛的19例熏表现为全腹痛11例,而明确有转移性右下腹痛的仅2…     

小儿急性阑尾炎与肠系膜淋巴结炎

小儿急性阑尾炎时常同肠系膜淋巴结炎进行鉴别诊断。教科书及有关阑尾炎的文献也屡屡提到二者容易混淆。更有医师在阑尾炎手术时见到阑尾炎症不明显，而肠系膜有肿大淋巴结就误认为这是肠系膜淋巴结炎。其实表现为急腹症的小儿肠系膜淋巴结化脓性炎症在临床上是很罕见的，笔者从事腹部外科40余年，处理阑尾炎数百例，但从未遇到     

小儿急性阑尾炎23例误诊分析

急性阑尾炎是小儿腹痛最常见的原因。由于小儿的特殊原因，误诊率相当高，有人报告达38．4％。作者回顾本院2000～2003年的102份小儿阑尾炎病历，有23例初诊时误诊，误诊率达22．5％，分析如下。     

小儿肠套叠误诊一例

中毒性菌痢是虫痢疾杆菌引起的肠道传染病，特别是4—6岁的小儿早期易误诊误治，应引起重视。     

小儿急性阑尾炎的误诊分析

小儿急性阑尾炎是小儿外科常见急腹症之一,发病初期至儿内科就诊的占绝大多数,且由于其年龄、解剖生理特点等特殊性,误诊和出现并发症的几率较高,故对于儿科尤其是儿内科医师来说,只有做到早期诊断,才能不延误患儿的最佳治疗时机.现收集整理我科2007年1月至2008年6月经CT和B超等辅助检查,且有完整临床资料并得到我院外科手术、病理证实的急性阑尾炎患儿67例,并作一回顾性研究.     

小儿阑尾炎诊治进展

阑尾炎是小儿腹部外科最常见的急腹症之一。随着我国国民经济发展，人们生活水平、文化素质及卫生知识的提高，目前大多数家长能及时带患儿到医院就诊，加之随着医疗事业的发展，临床医师诊治水平提高，其治疗效果令人鼓舞。但由于小儿阑尾炎病史症状常不典型，检查常不合作，病情发展迅速，有时诊断相当困难，处理不及时或不当可导     

小儿急性阑尾炎12例误诊情况回顾性分析

目的分析小儿急性阑尾炎的病例特点,提高诊断率,减少误诊发生。方法对12例小儿急性阑尾炎病例进行回顾性分析。结果本组患儿12例均于入院后24~48 h内转入本院外科,11例经手术治疗证实为急性阑尾炎,其中阑尾穿孔并发局限性或弥漫性腹膜炎4例,另外1例确诊为阑尾周围脓肿,经保守治疗后手术切除。结论对于无明确病因的急性发热、腹痛、呕吐、腹泻、腹胀患儿应高度警惕阑尾炎发生的可能,详细进行腹部体检和动态观察腹部体征变化,结合必要的辅助检查,降低误诊率。     

误诊急性阑尾炎2例分析

急性阑尾炎是腹部外科最常见的疾病,居急腹症之首,几乎每天都可以遇到。但在诊断上还是存在很多疑难,容易造成误诊。现将我们收治的2例报告如下。1病例资料病例1,女,5岁。于1999年11月3日因“转移性右下腹痛1d”收住。入院前1d进食后出现上腹部阵发性疼痛,间歇恶心呕吐。随后腹痛加重,逐渐转移至右下腹。查体:T36℃,腹平坦,软,右下腹压痛明显,未扪及包块,肠鸣音正常。血W BC10.28×109/L熏N87.8%熏L6.7%。入院诊断为“急性阑尾炎”,当日行急症手术,术中见腹腔内有少量淡黄混浊液体,回盲部肠系膜较长,淋巴结轻度肿大。仔细游离解剖回盲部,…     

CT for suspected appendicitis in children: an analysis of diagnostic errors

Background Mistakes have been made by the use of CT in diagnosing children with suspected appendicitis. Although others have reported the frequency of diagnostic errors, we were unable to find any studies that addressed the specific situations in which diagnostic errors occurred in children with suspected appendicitis. Objective To investigate the frequency and type of diagnostic errors resulting from CT of children with suspected appendicitis when compared to surgical and pathological diagnosis. Materials and methods We reviewed imaging, clinical and pathological data on 1,207 consecutive pediatric patients who underwent CT examination for suspected appendicitis. Imaging findings were categorized as false-positive, false-negative, or indeterminate. Errors were classified as interpretative, technical or unavoidable. Concordance between surgical and pathological findings was also evaluated. Results The imaging findings of 34 patients (2.8%) were discrepant with the pathological examination or clinical follow-up. The errors in 23 cases were classified as interpretive (68%) and 11 as unavoidable (32%), and no errors were classified as technical. There were 23 false-positive errors (68%), 6 false-negative errors (18%), and 5 indeterminate imaging studies (15%). Isolated CT findings of an enlarged (greater than 6 mm) appendix, fat stranding, thickened bowel or non-visualization of the distal appendix were the most common false-positive CT findings. Of these 34 patients, 22 underwent appendectomy, with 10 (45%) having discordant surgical and pathological findings. Conclusions Isolated CT findings of an appendicolith, an enlarged appendix, or minimal fat stranding are not sufficient signs for the diagnosis of appendicitis. Pathological diagnosis rather than surgical findings should be used as the reference standard of true-positive imaging findings.     

小儿穿孔性阑尾炎致病菌群特点及抗生素选用

目的　探讨小儿穿孔性阑尾炎致病菌群变化特点和抗生素的合理选用。方法　回顾性分析 2 0 0 2年 7月～ 2 0 0 3年 7月我院收治的 6 6例术中脓培养阳性的小儿穿孔性阑尾炎病例 ,男 5 2例 ,女 14例 ,平均 80 .3± 36 .4个月 ,分析致病菌群的变化、耐药性特点以及与抗生素使用的关系。结果　小儿穿孔性阑尾炎致病菌仍以大肠埃希菌和铜绿假单胞菌为主 ,但其他少见致病菌的比例上升 ,致病菌的种类与术后住院时间和静脉用抗生素的时间无显著相关性。结论　穿孔性阑尾炎致病菌谱变化不明显 ,术中脓培养对术后抗生素的选择具有指导意义。     

Do not rush into operating and just observe actively if you are not sure about the diagnosis of appendicitis

Purpose  The aim of this study was to determine whether the admission and active observation of children where the diagnosis of acute appendicitis is uncertain is a safe and effective way to improve the diagnostic accuracy of appendicitis and safely reduce the incidence of negative laparotomies without increasing complications. Methods  We performed a retrospective cohort study of children who presented with a complaint of right lower quadrant pain and were hospitalized with a diagnosis of appendicitis or suspected appendicitis from 1 January to 31 December 2007. Results  A total of 569 patients were included in the study. The mean age was 9.5 ± 3.2 (range 1.1–17) years. The number of patients directly operated on with a diagnosis of appendicitis was 186 (32%) from the total of 575 while 389 patients (68%) were observed in the surgical ward as the examination and/or investigation findings were equivocal. Of the 383 patients admitted for observation, 173 (45%) were operated on with a suspicion of appendicitis after 14.4 ± 6.7 h while 210 (55%) were discharged after 1.1 ± 1.2 days as there seemed to have no surgical problem. Our total negative appendectomy rate was 4% (14/350) and total perforation rate was 37.4% (131/350). The patients operated on directly and those operated on after observation were similar, and there was no difference for the preoperative duration of symptom, histopathological diagnosis, postoperative complication rate, postoperative inpatient days and hospital charges. Total hospitalization duration was significantly longer and the hospital charges significantly higher in the negative appendectomy group. Conclusion  Both the features and results and the complication rates and costs of the group operated on after observation were the same as the directly operated on group. However, patients undergoing a negative appendectomy stayed as inpatients longer than only observation patients with higher treatment charges. We could therefore decrease the negative appendectomy rate, the associated cost and duration of hospitalization without causing extra complications if we observe and investigate patients with right lower quadrant pain with a doubtful diagnosis and did not operate on them directly.     

Stress-related mucosal disease in childhood appendicitis

Stress-related mucosal disease (SRMD) is known to occur in critically ill patients both in the adult and paediatric population. Acute appendicitis is the most common surgical emergency in childhood and can precipitate SRMD. This possibility should be kept in mind, particularly in prolonged, complicated episodes. Although clinical complications of SRMD are rare, they may be highly significant in terms of haemorrhage or perforation and result in considerable morbidity or mortality. We provide a thorough review of the incidence, aetiology, role of Helicobacter pylori, risk factors, prophylaxis and management of this condition and describe a series of three cases of ulcerative SRMD in children with complicated appendicitis.     

腹部超声诊断在小儿急性阑尾炎的作用

目的 了解腹部B超在小儿急性阑尾炎诊断中的作用。方法 回顾了我院1999～2003年409例小儿急性阑尾炎住院的诊治经过。结果 409例患儿中225例患儿术前未行腹部B超检查，17例误诊，其中15例手术探查未发现明显病因。184例(44．99％)行术前腹部B超检查，其中27例入院诊断为腹部其他疾病，经腹部B超检查确诊为急性阑尾炎，184例B超检查病例中3例误诊，20例漏诊，漏诊患儿中单纯性阑尾炎11例，化脓性阑尾炎7例。结论 B超检查能减少小儿急性阑尾炎误诊率，有助于阑尾炎的确诊。     

儿童急性阑尾炎若干临床问题20年回顾分析

目的 急性阑尾炎是儿童外科常见疾病之一，本文旨在通过回顾性调查方法，对其临床诊断、手术和保守治疗、临床抗生素的应用、影像学检查的评价等作一分析，以有助于今后临床工作。方法 对我院小儿外科自1984年1月至2002年12月间因腹痛待查、急性阑尾炎收治的病例进行临床回顾性分析。内容包括流行病学特征，病理分型，抗生素的应用方案和并发症的处理。结果 我院小儿外科近20年中以腹痛待查、急性阑尾炎收治的患儿总共5733例，其中男3514例(占61．3％)，女2219例(占38．7％)，结果 提示急性阑尾炎发病率无季节性差异。收治病患中共行阑尾切除术5001例，阑尾穿孔率13．9％，阴性阑尾切除率22．0％；病理分型无季节差异，但近5年来阴性阑尾切除率显著降低；阑尾穿孔率无季节差异，但是近5年来阑尾穿孔率显著降低；对急性阑尾炎的抗生素应用包括庆大霉素、氨苄青霉素、先锋V号和甲硝唑等，术后并发症的发病率为4．7％(237／5001例)，其中包括粘连性肠梗阻，消化道出血，盆腔脓肿等；死亡1例(0．02％)。结论 儿童急性阑尾炎的临床处理重在及时的诊断和手术介入，对发病时间在16h以内的疑似患儿应行临床观察，必要时作B超鉴别，CT由于其射线侵袭性质，使用仍需审慎。     

Critical illness polyneuropathy following childhood appendicitis

Surgery for childhood appendicitis is considered to have good prognosis. Critical illness polyneuropathy (CIP) is a rare devastating neuromuscular disorder characterised by profound axonal motor dysfunction of unknown aetiology. We report a unique case of CIP in a young adolescent female at a regional pediatric surgery centre following operation for appendicitis. Prognosis with CIP is highly unpredictable as illustrated by the devastating outcome in this report. Health care professionals need to be proactive in triaging early referral of children with suspected appendicitis.     

儿童肌间血管瘤误诊原因分析及手术治疗

目的 探讨儿童肌间血管瘤的特点、分析误诊的原因、减少误诊的方法和手术治疗的关键点.方法 回顾性分析2001年7月至2010年7月经手术后病理检查证实的肌间血管瘤24例的治疗体会及误诊原因.结果 本组24例中有13例术前误诊,误诊率为54.2％.门诊获随访11个月～9年10个月,平均4年7个月.彻底切除的22例术后有1例复发;未完全切除术后2例复发,再次手术后没有再复发.随访时有5例轻微跛行或肌力下降,快步行走或奔跑时明显.无血管神经并发症.结论 儿童肌间血管瘤临床表现比较隐蔽,常规检查容易漏诊,应利用多种检查手段确诊,降低术前误诊率.术前明确病变范围,熟悉解剖位置,保护重要结构和肢体功能,争取彻底切除,如手术风险较大,应分次手术切除配合介入栓塞治疗.     

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。     

Early childhood appendicitis is still a difficult diagnosis

We report on 90 pre-school children operated on for suspected acute appendicitis. The data analysis was retrospective. The outcome of exploration was negative in 54% (49/90) of cases; inflamed non-perforated appendix was removed in 28% (25/90) and a perforated appendix in 18% (16/90) of cases. In infants aged >3 years ( n = 26) the perforation rate was 60%, and in children aged 4-5 years ( n = 64) it was 27%. Tenderness in the iliac fossa, blood leukocytosis and urinanalysis had little diagnostic value. Preoperative signs of diffuse peritonitis and elevated values of serum C-reactive protein were found more frequently only in the children with a perforated appendix. There was no mortality and the postoperative morbidity varied between 10 and 20%. Thus, although appendectomy is currently a safe procedure in children, more specific non-invasive diagnostic aids are still needed to reduce the number of negative explorations and the rate of perforation.