超声在急性阑尾炎诊断中的应用价值

目的 探讨超声检查在急性阑尾炎诊断中的应用价值。方法急性阑尾炎43例，男28例，女15例，年龄2-13岁，全部行超声检查及手术治疗。结果超声诊断明确37例，超声诊断的特异性为100％，敏感性为86％。单纯性阑尾炎的诊断率为72．7％，化脓性阑尾炎的诊断率为88．9％，坏疽性穿孔阑尾炎的诊断率为88．9％，阑尾脓肿的诊断率为100％。盲肠后位阑尾炎的诊断率为66．7％，盆位为94．1％，盲肠下位为90％。结论超声检查在急性阑尾炎的诊断中有重要的应用价值，但其受发病时间、阑尾位置、肠管胀气，特别是超声医师的经验的影响，对阑尾炎早期及盲肠后位阑尾诊断率较低，因此在阑尾炎的诊断中不能过分依赖超声检查的结果。     

腹腔镜阑尾切除术与开腹阑尾切除术治疗急性阑尾炎比较

目的 对比分析腹腔镜阑尾切除术(LA)与开腹阑尾切除术 (OA)治疗急性阑尾炎的疗效.方法 分析185例急性阑尾炎患儿的病例资料.其中85例患儿实施LA(LA组),术后病理证实单纯性阑尾炎30例,化脓性阑尾炎36例,坏疽穿孔阑尾炎19例;另外100例同期行OA患儿作为对照组(OA组),术后病理证实单纯性阑尾炎28例,化脓性阑尾炎38例,坏疽穿孔阑尾炎34例.比较不同类型急性阑尾炎患儿行LA及OA的手术时间、术后肛门排气时间、住院时间,发生腹腔脓肿、切口感染、肠梗阻例数.结果 单纯性阑尾炎、化脓性阑尾炎患儿行LA的术后肛门排气时间、住院时间短于OA组,手术时间长于OA组,差异均有统计学意义(Pa<0.05).坏疽穿孔阑尾炎患儿行LA的术后肛门排气时间短于OA组,差异有统计学意义(P<0.05);手术时间与OA组比较,差异有统计学意义(P<0.05);发生腹腔脓肿、切口感染例数均低于OA组,差异均有统计学意义(Pa<0.05).结论 对于单纯性和化脓性阑尾炎,LA在缩短住院时间、肛门排气时间,降低发生腹腔脓肿、术后切口感染、发生肠梗阻方面存在优势,但对于坏疽穿孔阑尾炎,LA在缩短肛门排气时间,降低发生腹腔脓肿及切口感染方面存在优势.     

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。     

小儿急性阑尾炎手术中腹腔冲洗的必要性探讨

目的通过对比各型小儿阑尾炎术中行腹腔冲洗与未行腹腔冲洗的疗效,探讨术中行腹腔冲洗的必要性。方法收集本院近3年内收治的急性阑尾炎病例共350例,其中A组为单纯性阑尾炎,行腹腔镜阑尾切除术;B、C组为化脓性阑尾炎未穿孔,B组行腹腔镜阑尾切除+腹腔引流术,C组行腹腔镜阑尾切除+腹腔冲洗+腹腔引流术;D、E组为坏疽穿孔性阑尾炎,D组行腹腔镜阑尾切除+腹腔引流术,E组行腹腔镜阑尾切除+腹腔冲洗+腹腔引流术。术后对患者资料进行详细统计和相应分析。结果急性单纯性阑尾炎行腹腔镜阑尾切除术后患儿预后良好。急性化脓性阑尾炎组术中行腹腔冲洗后,术后患儿肛门排气排便时间、直肠刺激症状、间断腹痛情况明显增加,且术后腹腔脓肿的发生率明显增多,术后5 d血常规白细胞稍高,1例并发右侧膈下脓肿,平均住院时间较未冲洗组明显延长;相反,急性坏疽穿孔性阑尾炎组,术中行腹腔冲洗后,患儿术后舡门排气排便时间缩短,术后腹腔残余感染、直肠刺激症状、间断腹痛情况降低,术后腹腔脓肿等并发症的发生率降低,术后5 d血白细胞较未冲洗组稍低。术后患儿恢复相对较快,住院时间短。结论小儿急性阑尾炎术中冲洗治疗应根据具体情况选择合适的方法,术中调节体位,充分显露脓腔,引流彻底,引流管位置适宜;急性化脓性阑尾炎未穿孔者不需行腹腔冲洗,而急性坏疽穿孔性阑尾炎则需术中行腹腔冲洗。     

经脐“︺”形切口阑尾切除术治疗小儿阑尾炎的疗效

目的探讨经脐"︺"形切口小儿阑尾切除术治疗小儿阑尾炎的临床疗效。方法回顾性分析42例急性阑尾炎患儿行经脐"︺"形切口小儿阑尾切除术的临床资料,其中男23例,女19例;年龄3～14岁,平均6.5岁。急性单纯性阑尾炎18例,慢性阑尾炎急性发作3例,急性化脓性阑尾炎18例,急性坏疽性阑尾炎3例,坏疽并穿孔2例。采用硬膜外麻醉或加基础麻醉,进行经脐"︺"形切口小儿阑尾切除术。结果 41例手术成功,1例改腹腔镜手术,手术时间15～70 min,平均37 min。术后住院3～7 d,平均4.1 d。30例切口轻微红肿,10例脐窝有积液,2例切口感染换药,所有切口愈合后外观满意,无粘连性肠梗阻、阑尾残株炎、粪漏、腹腔脓肿等并发症的发生。结论经脐"︺"形切口小儿阑尾切除术安全有效,适应证宽,损伤小,费用低,且美容效果好。     

小儿异位阑尾炎诊治36例报告

目的　总结 36例小儿异位阑尾炎的诊断及治疗经验。方法　分别行麦氏切口和探查切口证实腹膜外阑尾 11例 ,高位阑尾 6例 ,盆腔阑尾 18例 ,壁内阑尾 1例。其中单纯性 4例 ,化脓性 12例 ,坏疽穿孔 13例 ,阑尾周围脓肿 7例。结果　均行阑尾切除术 ,2 2例行腹腔引流 ,术后并发腹腔脓肿 7例、肠梗阻 2例、伤口感染 4例 ,均治愈。结论　小儿异位阑尾炎术易发生多种并发症影响康复 ,而及时诊断、妥善处理是防止术后并发症的关键。     

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…     

针式腹腔镜治疗急性阑尾炎67例

20 0 0年 1月～ 2 0 0 1年 12月我院对 6 7例小儿急性阑尾炎行腹腔镜手术 ,效果良好 ,现报告如下。资料与方法一、一般资料　本组 6 7例患儿 ,男 37例 ,女 30例。年龄1岁 10个月～ 12岁 ,中位数年龄 5 .6岁。急性单纯性阑尾炎14例 ,亚急性阑尾炎 19例 ,急性化脓性阑尾炎 2 5例 ,急性坏疽性阑尾炎 8例 ,并穿孔 2例 ,急性阑尾炎并阑尾周围脓肿 1例。二、方法　 1.手术器械 :10ｍｍ腹腔镜 ,2 .7ｍｍ针式镜 ,2 .7ｍｍ电凝钩 ,吸引器 ,分离钳。 2 .麻醉 :均采用气管插管麻醉。 3.切口 :脐环下缘做 10ｍｍ切口 ,穿刺入气腹针 ,保持二氧化碳气腹压 …     

新生儿急性阑尾炎

目的 探讨阑尾炎早期诊断特点及治疗效果。方法 回顾性分析我院1985年1月—2001年10月收治的新生儿阑尾炎病儿10例，及误诊为胎粪性腹膜炎、消化道穿孔、肠梗阻。结果 10例患儿有7例被误诊，10例患儿均经手术治疗阑尾切除，腹腔引流，均痊愈出院。其中1例合并阴囊脓肿切开引流治愈。病理检查：化脓性阑尾炎3例、坏疽穿孔性阑尾炎7例。结论 新生儿阑尾炎临床无特殊表现，术前诊断较为困难，误诊率高有相应症状时应排除此病。     

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     

A critical evaluation of US for the diagnosis of pediatric acute appendicitis in a real-life setting: how can we improve the diagnostic value of sonography?

Background

We have observed that day-to-day use of US for acute appendicitis does not perform as well as described in the literature.

Objective

Review the diagnostic performance of US in acute appendicitis with attention to factors that influence performance.

Materials and methods

Retrospective review of all sonograms for acute appendicitis in children from May 2005 to May 2010 with attention to the rate of identification of the appendix, training of personnel involved and diagnostic accuracy.

Results

The appendix was identified in 246/1,009 cases (24.4%), with identification increasing over time. The accuracy of US was 85–91% with 35 false-positives and 54 false-negatives. Pediatric sonographers were significantly better at identifying the appendix than non-pediatric sonographers (P?P?=?0.006). CT use was stable over the 5 years but declined in cases where the appendix was identified by US.

Conclusion

In day-to-day use, US does not perform as purported in the literature. We do not visualize the appendix as often as we should and false-negative and false-positive exams are too common. To improve the diagnostic performance of this modality, involvement by experienced personnel and/or additional training is needed.     

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.     

Acute appendicitis in children: comparison of clinical diagnosis with ultrasound and CT imaging

Background. There is strong evidence that imaging with ultrasound and CT can be of substantial diagnostic value in the diagnosis of acute appendicitis in children, but there is limited information of the impact of imaging on the management of these patients and its possible effect on surgical findings.¶Objective. We studied the impact of imaging in the management of acute appendicitis, in particular its effect on the rate of negative appendectomies and perforations.¶Patients and methods. We reviewed retrospectively the clinical records and imaging findings of 633 consecutive children and adolescents seen on an emergency basis with clinical suspicion of acute appendicitis. Two hundred seventy patients were operated upon on clinical evidence alone, while 360 were referred for US or CT, and occasionally both, because of doubtful clinical findings.¶Results. Acute appendicitis was found in 237 of those on clinical grounds alone, 68 of whom had perforation and related complications. Thus the rate of negative exploration and the rate of perforation were13 % and 29 %, respectively. One hundred eighty-two patients had preoperative US (sensitivity 74 %, specificity 94 %), 119 had CT (sensitivity 84 %, specificity 99 %), and 59 had both US and CT (sensitivity 75 %, specificity 100 %, but often with interpretation at variance with each other). The rate of negative appendectomy and perforation was 8 % and 23 %, respectively, for US, 5 % and 54 % for CT, and 9 % and 71 % when both examinations were performed. There is no statistical significance between the rates of diagnostic performance of US, CT, or their combination, nor between the negative appendectomy rates of each group, but the rate of perforation was significantly higher when CT was performed, alone or after US.¶Conclusion. The retrospective nature of the study prevents precise definition of the clinical characteristics and selection criteria for diagnostic examinations that may contribute to the management of children with suspected acute appendicitis. It was designed, however, to reflect the diagnostic approach and management of these patients, under the care of many decision makers and interpreters of imaging examinations, prevalent today in most hospital-based clinical practices. It is suggested that imaging increases diagnostic accuracy in difficult cases, but it might be one of the factors increasing the rate of perforations.     

小儿炎症阑尾肌间神经丛观察

目的 探讨小儿炎症阑尾壁肌间神经节及节内神经节细胞（节内细胞）数量变化，形态以及肌间乙酰胆碱酯酶染色纤维的数量变化的意义。方法 应用HE染色对1－13岁（平均6.9岁）急性单纯性阑尾炎40例，急性化脓性阑尾炎47例，急性坏疽性阑尾炎30例及42例对照组进行观察，分别取每个标本的尖端、中部、根部三处，测定肌间神经节密度（神经节总数／周长）及节内细胞数，并对其中各类型阑尾各6级及对照组7例的肌间乙酰胆碱酯酶阳性纤维进行观察。结果 炎症阑尾肌间神经节密度及节内细胞数较对照组减少，并随炎症的加重而明显减少；同一病理类型阑尾炎，从根部至尖端两参数亦呈递减趋势，而神经节细胞的成熟度无异常。胆碱酯酶阳性纤维也随炎症加重而明显减少。结论 炎症阑尾肌间神经节密度、节内细胞及胆碱酯酶染色数目减少与阑尾炎症程度关系密切。     

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。     

Appendicitis in infancy

Acute appendicitis is the most common cause of abdominal pain requiring surgery in children. But it is an uncommon entity in young children and rare in infants. During a 10-year period, between January 1991 and December 2000, 7 infants (age from 17 days to 8 months) were treated for acute appendicitis at Changhua Christian Hospital. All of the preoperative symptoms and signs, the duration between admission and operation, pathology reports, and laboratory data were reviewed. There were no specific clinical signs and symptoms. The duration between admission and operation ranged from 2 hours to 5 days (mean: 31.4 hours). The pathology reports revealed 3 were gangrenous, 3 were gangrenous with perforation and one was suppurative. There was one death. Pseudomonas aeruginosa was cultured from blood, ascites, bile or stool in 6 cases (85.7%). Early diagnosis of acute appendicitis in infants is still difficult. Although the mortality has declined, the morbidity still remains high. The high percentage of infection by Pseudomonas aeruginosa should be further evaluated in infantile appendicitis.     

Appendizitis

Appendicitis is the most frequent intraabdominal disease requiring surgical intervention. The clinical presentation can vary from acute abdominal pain to unspecific symptoms such as loss of appetite, fever, nausea and vomiting. The age of maximum frequency for appendicitis is between 6 and 12 years. Diagnosing acute appendicitis can be particularly challenging in young children, where symptoms are uncharacteristic and perforation can occur rapidly. The main factors influencing the outcome of appendicitis include accurate diagnosis followed by appendectomy prior to appendix perforation. Factors contributing to an almost 100% survival rate and a significant reduction in postoperative complications and long-term morbidity include the use of ultrasound and CT, anesthesia and surgical techniques especially suited to children, pediatric intensive care, as well as peri- and postoperative antibiotic therapy.     

早产儿急性阑尾炎4例临床分析及文献复习

目的探讨早产儿急性阑尾炎的临床特点及诊治体会,以提高对该病的早期识别和救治率。方法回顾性分析并总结解放军总医院第七医学中心八一儿童医院新生儿重症监护病房收治的4例早产儿急性阑尾炎的临床资料,包括临床表现、早期诊断、术中诊断等。同时在万方、中国知网、维普、PubMed等数据库中组合检索相关文献并分析。结果①病例资料:本文4例早期均以"腹胀"为首发症状,炎性指标明显升高,予以急诊手术,均术中诊断急性阑尾炎,其中2例为单纯急性阑尾炎,余2例为新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)合并阑尾炎。术后予积极抗感染、补液等治疗,4例均痊愈出院。②文献复习:经过阅读与筛选,中文文献数据库检索出早产儿急性阑尾炎文献8篇,Pub Med检索出10篇。国内外近30年早产儿急性阑尾炎相关文献报道较少,文献多以病例报道、误诊分析等为主。其中国内8篇文献,共报道早产儿急性阑尾炎35例,男27例,女7例,1例文献未描述性别;症状以腹胀、吐奶为主;32例穿孔,1例未穿孔,1例为早产儿阑尾炎合并肠套叠,另1例为合并腹股沟嵌顿疝;死亡1例(2.9%),其余均积极手术治疗后治愈出院。国外文献共10篇,早产儿急性阑尾炎共11例,男9例,女2例;穿孔5例,败血症2例,血便1例,腹股沟嵌顿疝3例,无死亡病例。11例中,早期均未诊断急性阑尾炎,均为术后诊断。结论早产儿急性阑尾炎无特异性临床表现,误诊率高,术前诊断较难,需结合腹部查体、X线片、B超及剖腹探查术明确。临床怀疑本病时应早手术探查,降低病死率。