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。     

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,     

小儿急性阑尾炎64例

我院自 1986年以来共收治小儿急性阑尾炎 6 4例 ,现将诊治体会报告如下。临床资料一、一般资料　男 38例 ,女 2 6例 ,年龄 3个月～ 14ａ ,5ａ以上占大多数。平均住院 8ｄ。单纯性 18例 (11.5 % ) ,化脓性 2 0例 (38.4% ) ,坏疽穿孔性 14例 (2 6 .9% ) ,阑尾周围脓肿 12例 (2 3.1% )。二、临床表现　均有阑尾炎的临床特点。较大患儿可有典型转移性右下腹痛史 ,但小患儿表现为哭闹。腹部有右下腹压痛及腹肌紧张。腹部触诊可发现右侧腹肌比左侧紧张。三、实验室检查　血白细胞计数升高 ,腹部Ｘ线检查可帮助鉴别肺部疾病、肠梗阻及消化道穿孔等…     

小儿急性阑尾炎早期诊断与治疗

小儿急性阑尾炎是小儿外科常见的急腹症之一，一般来说病势较成人严重，年龄越小临床症状越不典型，短时间内就会出现穿孔造成严重的并发症。因此，如何提高早期诊断水平，使小儿急性阑尾炎得到及时处理，确属一实际问题。现结合我院1995年收治的298例小儿急性阑尾炎，讨论早期诊断与治疗。一、临床资料1995年我院收治小儿急性阑尾炎298例，男199例，女99例，男女之比近2∶1。5岁以下45例，6～10岁125例，11～15岁128例。病理分型：单纯性阑尾炎131例（44％），化脓性阑尾炎128例（43％），穿孔性阑尾炎39例（13％）。全部病例主要临床症状…     

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 ,…     

我国小儿阑尾炎诊治现状评述

一、小儿阑尾炎现状：基本满意，最好不手术，不住院。小儿阑尾炎是学龄儿童常见病，北京儿童医院40年来每年平均500例，就诊率很稳定。40年来无死亡。全国城乡偶有死亡，也多因有特殊情况。诊疗方法基本上以“右下腹持续压痛、及时阑尾切除”为原则，临床技术各地无大变化。40年随着医学的进步与社会经济条件的提高，疗效的改善多表现为合并症     

耳“阑尾穴”诊断小儿急性阑尾炎的初步探讨

本文报道采用经络探测仪对50例急性阑尾炎病儿观察两耳“阑尾穴”及右下腹压痛点电流强度变化,发现对诊断急性阑尾炎具有一定临床意义,尤其两耳“阑尾穴”更具特异性。对婴幼儿或诊断困难病例有一定辅助价值.     

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。     

小儿阑尾炎误诊分析

目的 分析小儿阑尾炎的误诊原因，降低小儿阑尾炎的误诊率，减少术后并发症的发生。方法 回顾我院外科1997～2002年误诊的225例急性阑尾炎的临床资料，通过对其病史、手术所见，实验室及辅助检查结果进行回顾性研究，分析误诊原因。结果术前诊断为其他疾病，手术确诊为阑尾炎的163例；术前诊断为阑尾炎，手术证实为其他疾病的62例。全部病例均经手术治疗，术后痊愈出院，并发症的发生率为16.44％。结论 对小儿急性阑尾炎的临床症状特点缺乏足够的认识，腹部体征的掌握不准确及过多的依赖辅助检查是误诊的主要原因。对酷似阑尾炎的病例，应当允许阑尾误切的存在，但应注意诊断和鉴别诊断，尽量减少误切。     

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。     

急诊疑似阑尾炎VCT平扫与术后病理诊断对照准确性研究及影像学特征

目的以手术和病理诊断为金标准,探讨VCT平扫对急诊疑似阑尾炎的诊断价值。方法 2008年6月至2009年5月对急诊疑诊阑尾炎患儿行VCT平扫检查,与随后进行的外科手术病理学检查结果对照。统计分析VCT平扫诊断的准确性、敏感度、特异度、阴性似然比及阳性似然比。并分析急性阑尾炎和其他急腹症的VCT影像学特征。结果 284例患儿中手术和病理学检查诊断急性阑尾炎270例,VCT平扫诊断急诊阑尾炎243例。VCT平扫对急诊阑尾炎的诊断准确性为90%(95%CI:87%～92%)、敏感度为0.91(95%CI:0.87～0.94)、特异度为0.89(95%CI:0.85～0.93)。进一步根据阑尾炎病理学检查结果行亚组分析,结果显示,急诊单纯性阑尾炎的VCT诊断准确性为62.3%,急诊化脓性、坏疽性和穿孔性阑尾炎的诊断准确性均95%。漏诊和误诊的27例急诊阑尾炎中,包括23例单纯性阑尾炎,4例化脓性阑尾炎(3例被误诊为盆腔右侧附件病变,1例被误诊为右侧输尿管下端结石)。284例中14例为其他原因急腹症,VCT平扫准确诊断11例(78.7%),漏诊3例,包括肠系膜裂孔疝、梅克尔憩室扭转及索带压迫各1例。急性阑尾炎患儿典型的VCT特征为阑尾周围脂肪间隙模糊,阑尾增粗(直径为5～19mm),阑尾壁增厚。结论 VCT平扫对于急诊疑似阑尾炎的诊断具有显著意义,但对于单纯性阑尾炎的诊断准确性较低,必要时应行增强VCT检查以提高诊断准确性。     

A PLEA FOR INCIDENTAL APPENDECTOMY IN PEDIATRIC PATIENTS WITH MALIGNANCY

The evaluation of right lower quadrant (RLQ) abdominal pain in pediatric patients with malignancy can be difficult. However, since the mortality rate from peritoneal infections in these patients is very high, the differential diagnosis of RLQ peritoneal irritation, mainly of acute appendicitis (AA) versus neutropenic enterocolitis (NE), is crucial. Three cases of pediatric patients with malignancy demonstrating these difficulties are represented to enlighten this problem. The first patient died of multiorgan failure after operation for perforated appendicitis without generalized peritonitis. The second had a severe life-threatening postoperative complication because of delayed diagnosis of acute appendicitis. The third patient with malignant pelvic spread, underwent an unnecessary abdominal exploration for suspected AA. In all these cases and probably in many others, the clinical outcome could have been different if a previous incidental appendectomy had been performed during the primary abdominal operation. Incidental appendectomy in oncologic patients is recommended to facilitate the differential diagnosis of RLQ pain and to exclude the diagnosis of AA.     

降钙素原对儿童急性阑尾炎严重程度的预测价值

目的 评价降钙素原（PCT）对儿童急性阑尾炎严重程度的预测价值.方法 收集2011年10月至2012年3月我们收治的93例诊断为急性阑尾炎的患儿临床资料,包括年龄、性别、入院时PCT及CRP、并发症（腹腔脓肿、肠梗阻）、住院时间等.根据手术所见或病理检查结果将患儿分为急性阑尾炎组和急性阑尾炎伴局限性或弥漫性腹膜炎组.结果 急性阑尾炎组53例,腹膜炎组40例.腹膜炎组出现并发症的比例高于急性阑尾炎组,住院时间较长,且PCT、CRP水平显著高于急性阑尾炎组（PCT：0.43 vs 3.37 ng/mL,P＜0.001,CRP：3.0vs13.8 mg/L,P＜0.001）.在诊断腹膜炎的敏感性、特异性、阳性预测值、阴性预测值方面,当PCT以0.93 ng/mL为阈值时,分别为85.0％、91.6％、88.3％、89.0％,而CRP以4.05 mg/L为阈值时,分别为90.0％、67.9％、67.9％、90.0％.结论 入院时PCT及CRP对儿童急性阑尾炎的严重程度具有一定的预测价值,且PCT性能略优于CRP.     

Imaging the child with right lower quadrant pain and suspected appendicitis: current concepts

Acute appendicitis is the most common condition presenting with right lower quadrant pain requiring acute surgical intervention in childhood. The clinical diagnosis of acute appendicitis is often not straightforward and can be challenging. Approximately one-third of children with the condition have atypical clinical findings and are initially managed non-operatively. Complications usually result from perforation and include abscess formation, peritonitis, sepsis, bowel obstruction and death. Cross-sectional imaging with sonography and computed tomography (CT) have proven useful for the evaluation of suspected acute appendicitis in children. The principal advantages of sonography are its lower cost, lack of ionizing radiation, and ability to precisely delineate gynecologic disease. The principal advantages of CT are its operator independency with resultant higher diagnostic accuracy, enhanced delineation of disease extent in perforated appendicitis, and improved patient outcomes including decreased negative laparotomy and perforation rates.     

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.     

Primary peritonitis in previously healthy children

In a review of 22 years of clinical experience, we found seven previously healthy children with primary peritonitis. The diagnosis was made at laparotomy in all patients. Their symptoms included diffuse abdominal pain, fever, vomiting, and diarrhea. Abdominal tenderness was maximal in the right lower quadrant in five children, which led to confusion with the diagnosis of acute appendicitis. Streptococcus pneumoniae was identified as the etiologic agent in three patients and group A beta-hemolytic Streptococcus in one patient. The remaining three patients all had prior antibiotic therapy, and peritoneal fluid cultures were sterile. All children had a prompt response to treatment with antibiotics and recovered without complications. Long-term follow-up (4 1/2 to 15 years) was available for three patients; all three remained healthy.     

Validation and Refinement of a Prediction Rule to Identify Children at Low Risk for Acute Appendicitis

OBJECTIVE To validate and refine a clinical prediction rule to identify which children with acute abdominal pain are at low risk for appendicitis (Low-Risk Appendicitis Rule). DESIGN Prospective, multicenter, cross-sectional study. SETTING Ten pediatric emergency departments. PARTICIPANTS Children and adolescents aged 3 to 18 years who presented with suspected appendicitis from March 1, 2009, through April 30, 2010. MAIN OUTCOME MEASURES The test performance of the Low-Risk Appendicitis Rule. RESULTS Among 2625 patients enrolled, 1018 (38.8% [95% CI, 36.9%-40.7%]) had appendicitis. Validation of the rule resulted in a sensitivity of 95.5% (95% CI, 93.9%-96.7%), specificity of 36.3% (33.9%-38.9%), and negative predictive value of 92.7% (90.1%-94.6%). Theoretical application would have identified 573 (24.0%) as being at low risk, misclassifying 42 patients (4.5% [95% CI, 3.4%-6.1%]) with appendicitis. We refined the prediction rule, resulting in a model that identified patients at low risk with (1) an absolute neutrophil count of 6.75?×?103/μL or less and no maximal tenderness in the right lower quadrant or (2) an absolute neutrophil count of 6.75?×?103/μL or less with maximal tenderness in the right lower quadrant but no abdominal pain with walking/jumping or coughing. This refined rule had a sensitivity of 98.1% (95% CI, 97.0%-98.9%), specificity of 23.7% (21.7%-25.9%), and negative predictive value of 95.3% (92.3%-97.0%). CONCLUSIONS We have validated and refined a simple clinical prediction rule for pediatric appendicitis. For patients identified as being at low risk, clinicians should consider alternative strategies, such as observation or ultrasonographic examination, rather than proceeding to immediate computed tomographic imaging.     

Appendicite aiguë néonatale intra-herniaireAcute neonatal appendicitis in an inguinal hernia

Acute neonatal appendicitis is a rare surgical emergency. Prognosis depends on early diagnosis and management. CASE REPORT: A three and a half-month-old premature infant needed an urgent laparotomy because of an occlusive syndrome and sepsis with an inflammatory skin reaction. The per-operative diagnosis was suppurative acute appendicitis with local peritonitis, the appendix being strangulated into the inguinal hernia. DISCUSSION: Neonatal appendicitis represents 0.1% of all infantile appendicitis. Fifty percent of such cases occur in premature infants. Two clinical presentations exist, whose diagnosis is often made during surgery. The abdominal presentation (2/3 of the cases) can mimic necrotizing enterocolitis; the diagnosis is often late and evolution leads to diffuse peritonitis in the majority of the cases, while the mortality rate is higher than 50%. The intra-hernial presentation (1/3 of the cases), instead, is usually diagnosed and managed early due to the inguino-scrotal induration, while mortality rate is near zero. CONCLUSION: The high frequency of inguinal hernia in premature infants should not mask the risk for intra-hernial appendicitis. Inguino-scrotal inflammation should evoke the diagnosis. Prognosis depends on early and urgent surgical management.