儿童急性阑尾炎非手术治疗失败的相关危险因素分析

目的　分析儿童急性阑尾炎非手术治疗失败的危险因素，提高临床医师对该病的认识。方法　回顾性分析2013年1月—2018年12月我院儿科急性阑尾炎接受非手术治疗的158例患者资料，其中成功组110例，失败组48例。比较2组临床特征、实验室检查及腹部超声检查结果，采用Logistic回归分析儿童急性阑尾炎非手术治疗失败的危险因素。结果　成功组和失败组年龄、性别、腹痛时间、发热、呕吐、腹泻、腹胀、转移性右下腹痛及发病季节差异均无统计学意义（均P＞0.05）。实验室检查方面，2组患儿白细胞计数、中性粒细胞计数、淋巴细胞计数、C-反应蛋白比较差异无统计学意义（均P＞0.05）。腹部超声检查结果显示，失败组阑尾粪石（31.3% vs. 4.5%，χ2=21.555）和阑尾周围渗液（39.6% vs. 12.7%，χ2=14.587）发生率高于成功组（P＜0.01）；2组患者阑尾最大直径、阑尾壁厚度、腹腔淋巴结肿大比例比较差异均无统计学意义（P＞0.05）。Logistic回归分析结果发现阑尾粪石（OR=11.081，95%CI：3.567~34.421）、阑尾周围渗液（OR=5.196，95%CI：2.189~12.332）是儿童急性阑尾炎非手术治疗失败的危险因素。结论　阑尾粪石、阑尾周围渗液是儿童急性阑尾炎非手术治疗失败的危险因素，此类患者应引起临床医师重视，尽早采取手术治疗。

Analysis of risk factors associated with failure of nonoperative treatment ofacute appendicitis in children#br#

Objective To analyze the risk factors of nonoperative treatment failure in children with acute appendicitis, and to improve the understanding of the disease. Methods In this retrospective study, data of 158 patients with acute appendicitis after nonoperative treatment in our hospital from January 2013 to December 2018 were analyzed, including success group (n=110) and failure group (n=48). Clinical characteristics and laboratory findings including appendiceal imaging characteristics were compared between the two groups. Logistic regression analysis was used to determine the risk factors of failure in nonoperative treatment of acute appendicitis in children. Results There were no significant differences in age, gender, duration of abdominal pain, fever, vomiting, diarrhea, abdominal distension, metastatic right lower abdominal pain and onset season between the two groups (all P＞0.05). There were no significant differences in laboratory testing at admission including white blood cells, neutrophils, lymphocytes and C-reactive protein between the two groups (all P＞0.05). The abdominal ultrasound results showed that appendiceal fecalith (31.3% vs. 4.5%, χ2=21.555) and intraluminal appendiceal fluid (39.6% vs. 12.7%, χ2=14.587) were significantly higher in failure group than those of success group (P＜0.01). However, there were no significant differences in appendiceal maximal diameter, appendiceal wall enhancement and the proportion of abdominal enlarged lymph nodes between the two groups (P＞0.05). The multiple Logistic regression analysis showed that the appendiceal fecalith (OR=11.081, 95%CI: 3.567-34.421) and intraluminal appendiceal fluid (OR=5.196, 95%CI: 2.189-12.332) were the independent predictors of failure of nonoperative treatment in children with acute appendicitis. Conclusion Appendiceal fecalith and intraluminal appendiceal fluid are the risk factors for the value of nonoperative treatment in children with acute appendicitis. Such patients should arouse the attention and take surgical treatment as early as possible.