小儿阑尾炎辅助诊断及治疗新进展

阑尾炎是小儿腹部外科常见急腹症之一。约1／3的患儿以腹痛入院。小儿典型阑尾炎大都表现为腹痛、发热、右下腹固定压痛伴腹肌紧张及末梢血白细胞或中性粒细胞数升高。然而小儿阑尾炎的临床表现常不典型,从轻微的临床体征及正常的白细胞水平到并发肠梗阻及败血症休克等,     

腹部B超检查在急性阑尾炎诊断中的应用

急性阑尾炎是小儿外科常见的急腹症。根椐典型的临床症状为转移性右下腹痛、发热、消化道症状及白细胞升高，体检为右下腹麦氏点有固定压痛，诊断并不困难。但如不具备典型的病史、临床症状和体征，仅有腹痛及右下腹压痛的病人，诊断还缺少客观的依据。如不及时作出准确的诊断，会导致阑尾     

小儿髂骨骨髓炎三例诊治体会

小儿髂骨骨髓炎发病率低 ,早期表现不典型 ,误诊率高。总结我院 1990～1999年收治的 3例患儿 ,探讨诊治失误的原因及预防措施。临床资料例 1:男 ,6岁。因发热 (Ｔ 38.6℃ )伴右下腹痛 1ｄ入院 ,经体检、血常规及腹透检查诊断为急性阑尾炎 ,手术切除阑尾无炎症改变。术后发现右髂嵴深压痛 ,压痛最明显部位穿刺抽出 1.5ｍｌ脓血样液体 ,支持骨髓炎诊断 ,ＣＴ扫描证实。手术刮除病灶 ,置管引流冲洗 ,抗炎治疗 2 0ｄ治愈。例 2 :男 ,10岁。因低热伴右下腹隐痛于当地医院诊断为阑尾炎 ,保守治疗1周后病情缓解 ,停药 3ｄ后又有低热 ,伴右髂部痛 ,…     

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。     

梅克尔憩室扭转误诊为急性化脓性阑尾炎1例

患儿,男,10岁,体重52kg,因转移性右下腹痛3天伴发热2天急诊人院,患儿3天前无明显诱因出现腹痛,为间断性,较剧烈,就诊于当地县医院,诊断为肠痉挛。2天前转诊另一家医院,查血常规,提示白细胞15．02×10^9／L,N71％,CRP214mg／L,大便无异常,诊断为急性肠炎,予经静脉输入头孢类抗生素,疼痛无好转,无恶心呕吐,后出现发热,体温最高38．7℃。1天后转诊于本院,腹部B超提示急性化脓性阑尾炎,体查：全腹肌紧张,压痛、反跳痛阳性,右下腹为著,未扪及包块,叩诊鼓音,移动性浊音阴性,右下腹压痛阳性,反跳痛阳性,结肠充气试验阳性,诊断为急性化脓性阑尾炎。予积极术前准备后行腹腔镜下阑尾切除术,     

二孔法腹腔镜小儿阑尾切除术体会

我院腹腔镜外科 2 0 0 2年 1～ 8月对14例急性单纯性阑尾炎和蜂窝组织炎性阑尾炎行二孔法腹腔镜阑尾切除手术(laparoscopyappendectomy ,LA) ,取得较好效果 ,现报告如下。临床资料一、一般资料本组 14例 ,男 4例 ,女 10例 ;年龄 5岁 2个月～ 14岁 ,平均 9岁 1个月 ;临床表现为呕吐、腹痛、发热。发病时间 5～18h ,平均发病时间 12h。体检均发现右下腹固定性压痛 ,无明显肌紧张及反跳痛。实验室检查发现 9例白细胞 >10× 10 9/L ,5例在正常范围。根据病史及临床表现诊断小儿急性阑尾炎。术后病理检查确诊为单纯性阑尾炎 8例、蜂窝组织炎 6…     

小儿阑尾套叠1例

小儿阑尾套叠１例孙玉成，张远水患儿：男，４岁。因阵发性右下腹痛伴恶心、呕吐１２小时于１９９５年１１月６日入院。入院时有排气、排便。体检：急性病容，右下腹麦氏点压痛明显。血常规：白细胞１６．０×１０９／Ｌ。腹部透视：下腹部有３处气液平面。诊断急性阑尾炎...     

彩色多普勒超声诊断小儿急性阑尾炎的临床应用研究

目的探讨彩色多普勒超声诊断小儿急性阑尾炎的临床应用。方法对临床拟诊的78例急性阑尾炎的患儿全部行彩色多普勒超声检查以明确诊断及鉴别诊断。结果78例临床拟诊的急性阑尾炎病人，经彩色多普勒超声检查诊断为急性阑尾炎的51例，全部行手术治疗，经手术及术后病理检查50例证实为急性阑尾炎。本组出现假阳性1例，假阴性1例，准确率为97．7％。结论采用无创伤性、简单安全的彩色多普勒超声诊断小儿急性阑尾炎可靠、准确，值得推广应用。     

白血病患儿伴发阑尾炎的诊治体会

目的探讨白血病患儿伴发急性阑尾炎的诊断、治疗方法、手术时机及预后。方法回顾分析2013年1月—2018年9月收治的12例白血病患儿并发急性阑尾炎诊断并行腹腔镜阑尾切除术的临床资料,并复习相关文献。结果患儿在全麻下完成腹腔镜阑尾切除术10例,保守治疗2例。术后出现高热3例,盆腔积脓3例,脐部穿刺孔渗血、积血1例,均经处理后治愈出院,无死亡病例。结论白血病患儿伴发急性阑尾炎,诊断多依赖体征及超声,一旦确诊应首选手术治疗。腹腔镜阑尾切除术并发症少、康复快、住院时间短,为治疗白血病患儿并发急性阑尾炎提供了很好的选择。     

C—反应蛋白在小儿急性阑尾炎的临床意义

通过对33例小儿急性阑尾炎、10例腹痛及35名正常儿童CRP 测定,发现CRP 不仅与炎症严重程度有关,且与发病时间有关。对小儿急性阑尾炎,CRP 的诊断价值高于白细胞和血沉,CRP 可在阑尾炎患儿术前估计病变并鉴别阑尾是否穿孔,其测定对小儿急性阑尾炎的诊断与鉴别诊断有重要意义。     

Febrile neutropenia as the presenting sign of appendicitis in an adolescent with acute myelogenous leukemia

The diagnosis and management of a surgical abdomen in patients with acute leukemia is quite difficult because of the complications and treatment of disease itself. A 13-year-old boy with acute myelogenous leukemia developed 2 episodes of febrile neutropenia during induction therapy. The second one was treated with a 5-day course of parenteral antimicrobial therapy, but the patient then presented with right lower quadrant abdominal tenderness, guarding, and rebound tenderness. Abdominal ultrasonography and computed tomography revealed appendicitis. Conservative medical management was unsuccessful, and appendectomy was performed 5 days after appendicitis was diagnosed. The patient's clinical manifestations resolved 5 days later. The case illustrates that fever may be the first manifestation of appendicitis in a child with acute myelogenous leukaemia who is neutropenic. Surgery is acceptable as first-line treatment in such cases.     

Improving the diagnosis of acute appendicitis in children with atypical clinical findings using the technetium-99m hexamethylpropylene amine oxime-labelled white-blood-cell abdomen scan

BACKGROUND: Diagnosing acute appendicitis in children with equivocal signs and symptoms may be difficult. The usual approach is hospital observation and frequent re-examination. However, many surgeons are reluctant to delay surgery because of the risk of perforation and a negative laparotomy. OBJECTIVE: To assess and compare the value of the technetium-99m hexamethylpropylene amine oxime ((99m)Tc-HMPAO)-labelled white-blood-cell (WBC) abdomen scan in the diagnosis of acute appendicitis in children with atypical clinical presentation. PATIENTS AND METHODS: Fifty children with acute right lower quadrant abdominal pain and possible acute appendicitis, but atypical findings were included. After IV injection of (99m)Tc-HMPAO-labelled WBCs, serial anterior abdomen scans were obtained using a gamma camera. RESULTS: Thirty-three children underwent surgery, while 17 children were managed conservatively and were followed up for at least 1 month. Four children had false-positive results and one child had a false-negative scan result. The overall sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the scan to diagnose acute appendicitis in children with atypical findings was 96.7, 80.0, 90.0, 87.8 and 94.1%, respectively. CONCLUSIONS: The (99m)Tc-HMPAO WBC abdomen scan is a potential tool for diagnosing acute appendicitis in children with atypical clinical findings. The high sensitivity and negative predictive value allows early discharge from the emergency department to avoid costly observation in hospital and potentially unnecessary surgery in those patients with negative scans.     

小儿血液系统恶性疾病合并外科急腹症的诊治分析

目的探讨小儿血液系统恶性疾病合并外科急腹症的诊断与治疗,以提高对小儿恶性血液病并发急腹症的认识,改善该类患者的预后。方法对13例恶性血液病并发急腹症患者进行回顾性分析。13例中,急性淋巴细胞白血病6例,MDS转化的急性髓细胞白血病1例,慢性粒细胞白血病1例,红白血病1例,再生障碍性贫血2例,淋巴瘤2例。7例行手术治疗,6例予保守治疗。结果7例手术患儿中,4例急腹症获治愈,待内科疾病缓解后出院;1例急腹症治愈,后死于内科疾病;2例术后早期自动出院,其中1例死亡。6例保守治疗患儿中1例死亡,5例临床症状缓解。结论各种恶性血液病在疾病的任何阶段均可并发多种急腹症,手术治疗是挽救患儿生命的重要手段之一。应根据原发病所处的阶段以及急腹症的类型和严重程度,给予及时诊断和恰当治疗,以利于改善该类患者的预后。     

血液病并发急性盲肠升结肠炎的外科处理

目的急性盲肠升结肠炎是儿童血液病的严重并发症，本文讨论其诊断和处理。方法总结我院的临床病例资料，并行文献复习。结果过去5年间诊断血液病并发急性盲肠炎的病例共7例，主要症状是在血液粒细胞严重减低的基础上，出现右下腹痛伴高热和腹泻，CT、B超可提示盲升结肠壁增厚，保守治疗可获明显疗效。结论血液病治疗中出现急性腹痛的患儿，除了考虑阑尾炎外应注意盲升结肠炎的可能。高热、腹泻和CT检查中出现结肠和盲肠壁增厚或壁内积气常是盲肠炎的依据。治疗上以保守治疗为主。     

Association of streptococcal pharyngitis with complicated appendicitis]

Streptococcal pharyngitis can be accompanied by right lower abdominal quadrant pain, which often is linked to mesenteric adenitis. We report on a case of such misleading association in a child. CASE REPORT: A 6-year-old child presented pain in the right lower abdominal quadrant and fever with 39 degrees C temperature for 24 h; clinical examination showed pharyngeal erythema and local abdominal tenderness. Strep-test was positive. Abdominal ultrasound visualized signs of appendicitis. The child was operated on for complicated appendicitis. COMMENTS: The association of pharyngitis and appendicitis is particularly misleading because mesenteric adenitis is the most common cause of right lower quadrant tenderness in children with pharyngitis.     

Yersinia enterocolitica infection mimicking surgical conditions

Yersinia enteritis may present with alarming gastrointestinal manifestations. The aim of this study was to review the cases of children admitted to a general hospital with a preliminary diagnosis of surgical nature and subsequently proven to be infected by Yersinia enterocolitica. All cases of children aged less than 14 years with stool cultures positive for Y. enterocolitica during the 12-year period January 1993 through December 2004 were analyzed. Y. enterocolitica was isolated from the stools of 71 children with gastrointestinal manifestations; 27 children were treated as outpatients and 44 were hospitalized. Six were admitted to the Pediatric Surgery Department (13.6% of the total hospitalizations and 8.4% of all Y. enterocolitica cases). Four of the Pediatric Surgery patients presented with abdominal pain and right lower quadrant tenderness. The preliminary diagnosis of appendicitis was excluded during hospitalization and none of them underwent appendectomy. The other two children were admitted for vomiting initially attributed to a preceding head injury and for diarrhea and a perianal abscess. Two children were given antibiotics and all had an excellent outcome. Y. enterocolitica enteritis manifestations can infrequently mimic appendicitis or other surgical conditions but should remain in the differential diagnosis of children presenting with an acute abdomen.     

Results and complications of induction treatment of acute leukemia in children. A personal series of 79 cases (1988-1989)]

In 1988 and 1989, 79 children have been treated for induction of acute leukemia. 68 presented an acute lymphoblastic leukemia (ALL) and 11 an acute non-lymphoblastic leukemia (ANLL). The complete remission rate was 92% (96% in ALL, 73% in ANLL). Fever occurred in 50% of the children, with positive blood cultures in 11 of them. One child died from streptococcal sepsis. No metabolic disorder was noted. Four patients were transferred into the intensive care unit. After 8 days, the treatment of ALL was continued in the outpatient clinic in more than 50% of the cases. The treatment of ANLL is frequently complicated by hemorrhages and sepsis and needs adapted supportive care in a specialized unit.     

Intestinal obstruction at the onset of acute lymphoblastic leukemia in a child

Surgical complications need not be fatal in acute leukemia. If these are promptly diagnosed and properly treated, the prognosis will improve. This report deals with a case of acute lymphoblastic leukemia presenting with an acute abdomen following surgery for choledochal cyst. A peripheral blood smear and examination of the bone marrow revealed acute lymphoblastic leukemia. The child received transfusions of blood and platelets. Pretreatment with prednisolone was started as therapy for leukemia, and 2 days later, the patient underwent surgery. Therapy was continued until the general condition allowed a more aggressive form of treatment. Complete remission was achieved, and the patient is still in good health 48 months after diagnosis and 15 months after discontinuation of treatment. The favorable outcome in this child shows that prompt surgery is sometimes an essential step in the treatment of childhood leukemia.     

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。