摘要
目的分析不同年龄段儿童急性穿孔性阑尾炎流行病学和临床表现的差异，为改进急性穿孔性阑尾炎的早期诊断提供理论依据。方法收集近20年本院收治的急性穿孔性阑尾炎患儿的临床资料。根据年龄分为新生儿及婴幼儿组（1d至3岁）、学龄前组（4～7岁）、小学年龄组（8～12岁）、青春期组（13～16岁）。统计穿孔性阑尾炎的性别比例和年龄分布。计算比较不同年龄段患儿的穿孔率。比较不同月份不同年龄段患儿穿孔性阑尾炎的发病情况。分析不同年龄段患儿穿孔性阑尾炎主要临床症状、体征、实验室及影像检查的差异。结果本院近20年共收治急性阑尾炎5859例，其中穿孔性阑尾炎1446例，男936例，女510例，男女比1．84：1，总穿孔率为24．68％。不同年龄段患儿阑尾炎穿孔率分别为：新生儿及婴幼儿组28．65％，学龄前组28．63％，小学年龄组22．64％，青春期组13．35％。穿孔性阑尾炎发病呈季节性分布，其中夏季7、8、9三个月发病率最高，而2、3、4三个月发病率最低。腹痛是各年龄组最常见症状，各年龄组发生率无明显差异（P〉0．05）。转移性右下腹痛仅出现于15．70％的患儿中，且随年龄增长发生率逐渐增加。发热、呕吐、厌食、腹泻等症状发生率随年龄增长逐渐降低，差异有统计学意义（P〈0．05）。而转移性右下腹痛和腹部压痛及肌紧张的发生率随年龄增长逐渐升高，差异有统计学意义（P〈0．01）。中性粒细胞比例新生儿及婴幼儿组低于小学年龄组和青春期组，C反应蛋白水平新生儿及婴幼儿组高于小学年龄组和青春期组，差异有统计学意义（P〈0．05）。腹部平片和B型超声显示青春期组肠梗阻征和肠壁增厚伴蠕动减少的发生率高于其他各组，B型超声和CT显示小学年龄组和青春期组阑尾粪石出现率高于新生儿及婴幼儿组和学龄前组，差异有统计学意义（P〈0．05）。结论阑尾炎穿孔率随年龄的变化而不同。穿孔性阑尾炎发病呈季节性分布。不同症状、体征在不同年龄组的发生率有显著差异。不同年龄组患儿中性粒细胞比例和C反应蛋白不同。部分影像学表现在不同年龄组患儿中出现率不等。
Objective To examine the epidemiology and clinical features of perforated appendici- tis （PA） in children by age group. Methods Medical charts of pediatric acute appendicitis （AP） pa- tients hospitalized between January 1991 and December 2010 were retrospectively reviewed. All pa- tients were divided into four age groups： group Ⅰ ： ld-3yr; group Ⅱ ： 3yr-7yr; group Ⅲ ： 7yr-12yr; and group Ⅳ： 12yr-16yr. Results Among 5859 AP patients, 1446 patients （24. 68%） suffered from PA （male to female 936：510）. The perforation frequency of each subgroup was 28. 65%, 28. 63%, 22. 64%, and 13. 35%, respectively. The incidence of PA showed clear seasonality with a peak in summer. Abdominal pain was the most frequently complained symptom, with a constant frequency a- mong all age groups （P〉0. 05）. Shifting pain was reported in only 15.70% of patients and showed a frequency increasing with age. As compared to groupsⅢ and Ⅳ, groups Ⅰ and Ⅱ were more likely to complain of non-specific gastrointestinal symptoms （P〈0. 05）, but less likely to exhibit appendicitis- associated abdominal signs （P〈0. 01）. Neither the overall white cell count nor frequency of leukocy-tosis varied significantly among four age groups （P〉 0. 05）. Neutrophil was significantly lower in group Ⅰ than tha in groups III and IV （P〈0.05）. Serum C-reactive protein level was significantly higher in group Ⅰ than that in groups Ⅲ and Ⅳ （P〈0. 05）. Abdominal radiographs in group IV were more likely to show signs of bowel obstruction or pseudo-obstruction as compared to group Ⅰ-Ⅲ （P〈0. 05）. Fecaliths were more frequently observed in groups Ⅲ and IV （P〈0. 05）. Conclusions Youn- ger pediatric patients have a higher risk of complicating PA, and also differ significantly from their ol- der counterparts in terms of clinical features.
出处
《中华小儿外科杂志》
CSCD
北大核心
2013年第11期814-818,共5页
Chinese Journal of Pediatric Surgery
基金
上海市科委重点基金（044119602）
