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。

The experiences of diagnosis and treatment of acute appendicitis in children

Objective To evaluate the diagnosis and treatment of acute appendicitis in children. Methods There were 940 children with acute appendicitis including 19 cases combined with leukemia and other disorders were treated at the Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China from June 1998 to June 2003. Their symptoms and signs were reviewed, and the clinical features and the methods of treatment were analyzed. Results Fever, abdominal pain, tenderness over the right lower quadrant of the abdomen and increased WBC in the blood were the most findings. 939 of the 940 cases including 18 children combined with leukemia or disorder in the blood and other problems, were treated by surgical operations. The diagnoses were confirmed at operation and pathological examination. Only one patient with leukemia was treated by conservative method because the parents refused surgery for their child. All patients treated by surgery were cured and the one without operation was relieved by conservative treatment. However, the longer result of that patient was not clear for she was followed up in a local hospital at her hometown. Conclusions Fever, abdominal pain, tenderness over the lower right quadrant of the abdomen and increased WBC in the blood are the major evidences for diagnosing acute appendicitis in children. Surgical operation should be carried out once the diagnosis of acute appendicitis is made in a child, especially in young child whose symptoms are atypical. Surgery under proper preoperative preparations still is the treatment of choice for patient also with leukemia, hematological disorders and other troubles.