5岁及以下儿童急性阑尾炎——单中心12年回顾性分析

Acute appendicitis in≤5-year-old children: a 12-year retrospective single-center analysis

摘要:

目的： 回顾性分析5岁及以下儿童急性阑尾炎（acute appendicitis，AA）的临床特点及阑尾切除后的临床结局。方法： 收集5岁及以下AA患儿（538例）临床资料，根据术中所见及病理结果将其分为复杂性阑尾炎（complex appendicitis，CA）组（326例）和单纯性阑尾炎（simple appendicitis，SA）组（212例），对比分析2组临床资料。结果： ①CA组患儿中位数年龄（3.4岁vs 4.3岁，P=0.000）低于SA组，而入院体温（38.4℃vs.38.1℃，P=0.000）、病程时间（26 h vs.24 h，P=0.000）高于SA组，CA组呕吐、腹泻、反跳痛及腹胀等症状发生率高于SA组（均P=0.000）。②CA组术前白细胞计数、中性粒细胞计数、淋巴细胞计数及降钙素原水平高于SA组（均P<0.05），其中白细胞计数对CA预测效能较高，ROC曲线下面积为0.738（95%CI=0.695~0.781）。③CA组住院时间、抗生素使用时间及术中出血量高于SA组，术后并发症发生率均高于SA组（均P<0.05）。结论： 5岁及以下儿童AA的临床表现不典型，CA与SA患儿的临床表现、化验指标及临床结局具有一定差异。

Abstract:

Objective: To retrospectively analyze the clinical characteristics of acute appendicitis (AA) and outcomes after appendectomy in≤5-year-old children. Methods: The clinical data of 538 children with AA aged five years or younger were collected retrospectively. According to the intraoperative findings and postoperative pathological examination, they were divided into complex appendicitis (CA) group (n=326) and simple appendicitis (SA) group (n=212). Clinical data of the two groups were compared and analyzed. Results: ①The median age of children in CA group was lower than that in SA group (3.4 years old vs.4.3 years old, P=0.000), while the admission temperature (38.4℃vs.38.1℃, P=0.000) and symptom duration (26 h vs.24 h, P=0.000) in CA group were higher than those in SA group, and the incidences of vomiting, diarrhea, rebound tenderness and abdominal distension in CA group were higher than those in SA group (all P<0.05).②The levels of white blood cell count, neutrophil count, lymphocyte count and procalcitonin level in CA group were higher than those in SA group before operation (P<0.05). In addition, white blood cell count was more effective in predicting CA, and the area under the ROC curve was 0.738 (95%CI=0.695-0.781).③The hospitalization time and postoperative antibiotic use time in CA group were longer and the intraoperative blood loss of children in CA group were greater than those in SA group (all P<0.05). Conclusion: The clinical manifestations of AA in children aged five years or younger are not typical. There were some differences in clinical manifestations, assay indicators and clinical outcomes between CA and SA children.