新生儿和婴儿急性阑尾炎的临床特点

目的：探讨新生儿和婴儿急性阑尾炎的临床特点，降低临床误诊率，改善预后。方法：收集我院1993年2月至2018年7月收治的1岁以内小儿急性阑尾炎的病例资料，按照年龄划分为新生儿组和婴儿组，比较两组患儿的临床特点。结果：共收集87例，其中新生儿组31例，婴儿组56例，经内科保守治疗或手术切除治疗后均治愈，无死亡病例。新生儿组腹胀、拒乳及反应差、腹部膨隆、腹壁静脉显露、腹壁红肿、肠鸣音减弱发生率均高于婴儿组，而呕吐、烦躁哭吵、右腹股沟包块/腹部包块发生率均低于婴儿组（P均<0.05）。在病理类型中，新生儿组以坏疽性阑尾炎为主，而婴儿组以单纯性阑尾炎为主。新生儿组患儿的住院时间长于婴儿组（P<0.05）。结论：新生儿急性阑尾炎住院时间长，易穿孔，临床表现以腹胀、拒乳及反应差、腹壁静脉显露、腹壁红肿、肠鸣音减弱等表现为主，无特异性，临床易误诊、漏诊。当患儿出现腹胀等消化道症状，且腹部体征提示腹腔内有炎症时，需高度警惕。可有效结合临床症状及体征、腹部超声，必要时剖腹探查以明确诊断，及早治疗，改善预后。

Clinical Characteristics of Acute Appendicitis in Newborns and Infants

Objective: To probe into the clinical characteristics of acute appendicitis in newborns and infants, so as to reduce the clinical misdiagnosis rate and improve the prognosis. Methods: Clinical data of acute appendicitis children under 1 year old admitted into our hospital from Feb. 1993 to Jul. 2018 were extracted. According to different age groups, all patients were divided into the newborn group and the infant group. Clinical characteristics of two groups were compared. Results: Totally 87 cases were enrolled, including 31 cases in the newborn group and 56 cases in the infant group. All children were cured after conservative medical treatment or surgical resection, and there were no deaths. The incidence of abdominal distension, milk rejection and poor response, abdominal distension, exposure of abdominal vein, abdominal swelling and decreased bowel sound in the newborn group was higher than that in the infant group, while the incidence of vomiting, irritable crying and right inguinal mass/abdominal mass was lower than that in the infant group (P<0.05). In the pathological types, the newborn group was dominated by gangrenous appendicitis, yet the infant group was dominated by simple appendicitis. The length of stay of the newborn group was longer than that of the infant group (P<0.05). Conclusion: Acute appendicitis in the newborn has relatively long length of stay and is prone to perforation. The clinical manifestations are mainly abdominal distension, breast rejection and poor response, exposure of abdominal vein, abdominal swelling and decreased bowel sound. There is no specificity, and the clinical diagnosis is easy to be misdiagnosed and missed. Gastrointestinal symptoms such as abdominal distension and abdominal signs in children suggest inflammation in the abdominal cavity, high vigilance is required. Therefore, diagnosis should be made after combining clinical manifestations, abdominal ultrasound and exploratory laparotomy when necessary, so as to obtain early treatment and improve the prognosis.