小儿阑尾炎早期诊断的临床研究——30年10256例小儿阑尾炎经验总结

目的总结连续30年10256例小儿阑尾炎的诊断治疗经验，提出早期诊断的临床标准，为早期手术治疗提供依据，以降低病死率，减少并发症。方法统计1980年至2009年本院收治的小儿阑尾炎病例10256例，使用32项临床指标进行对比研究，提出核心诊断指标指导临床早期诊治。在新的理念指导下，分析前10年及后20年，阑尾炎病例在腹膜炎的发生率以及阑尾炎病理类型上的变化，探讨早期诊断标准在提高阑尾炎诊治水平方面的实际意义。结果10256例阑尾炎病例中，死亡1例，死亡率小于1／10000。8241例阑尾炎病例的有效统计中，持续性右下腹疼痛或伴哭吵不安症状的患儿8131例（98．67％），右下腹固定压痛8103例（98．33％）。实施早期诊断标准后，阑尾炎穿孔形成腹膜炎的发生率从早期的43．82％降低为29．88％。10256例中，595例为婴幼儿阑尾炎，466例并发阑尾周围脓肿。结论持续性右下腹疼痛及右下腹固定压痛是临床诊断小儿阑尾炎的核心指标，既是必要的，也是充分的。小儿阑尾炎的临床早期诊断是提高治愈率，减少并发症的关键。

The clinical study of early diagnosis of pediatric acute appendicitis A 30-year experience.

Objetive Introducing a new early diagnostic criteria of pediatric acute appendicitis by sum- marizing the experience of 10 256 cases acute appendicitis over three decades in order to provide basis for early operative treatment, to reduce severe complication and mortality of patient with appendicitis. Methods The non-selective and continuous clinical data （ clinical symptoms, the rate of peritonitis and pathological type） of 10 256 cases was analyzed comprehensively to provide the fundamental matter for the diagnosis of pediatric acute appendicitis to guide clinical early diagnosis and treatment. To investigate the significance of the early di- agnostic criteria on raising the level of diagnosis and treatment of appen~tieitis by comparing the data of the peri- tonitis rate and the change of pathological type of the first decade with that of the second two decades under the new standard. Results Only one patient in 10 256 acute appendicitis cases died and the mortality of which is less than 1/10 000. Of a total 8 241 patients, 8 131 （98.67%） underwent persistent fight lower quadrant ab- dominal pain or being upset, patients with fight lower quadrant fixed abdominal tenderness accounted for 98.33% （8 103 cases）. After the implementation of early diagnostic criteria, the incidence of appendicitis per- foration peritonitis decreases from the early 43.82% to 29.88%. The characteristic of appendicitis in children younger than 3 years of age and appendiceal abscess also be analyzed in this paper. Conclusions Persistent fight lower quadrant abdominal pain and right lower quadrant fixed tenderness could be the fundamental matter for the diagnosis of acute appendicitis, also be an essential and sutficient matter. This clinical diagnostic principle of appendicitis in children should improve the cure rate and reduce complications of pediatric acute appendicitis.