中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2013年
11期
814-818
,共5页
孙松%Bal Mukunda Basnet%郑珊%徐梦华%陈功%秦宏
孫鬆%Bal Mukunda Basnet%鄭珊%徐夢華%陳功%秦宏
손송%Bal Mukunda Basnet%정산%서몽화%진공%진굉
阑尾炎%儿童%年龄因素%流行病学
闌尾炎%兒童%年齡因素%流行病學
란미염%인동%년령인소%류행병학
Appendicitis%Child%Age factors%Epidemiology
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1 5.70％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.
目的 分析不同年齡段兒童急性穿孔性闌尾炎流行病學和臨床錶現的差異,為改進急性穿孔性闌尾炎的早期診斷提供理論依據.方法 收集近20年本院收治的急性穿孔性闌尾炎患兒的臨床資料.根據年齡分為新生兒及嬰幼兒組(1d至3歲)、學齡前組(4～7歲)、小學年齡組(8～12歲)、青春期組(13～16歲).統計穿孔性闌尾炎的性彆比例和年齡分佈.計算比較不同年齡段患兒的穿孔率.比較不同月份不同年齡段患兒穿孔性闌尾炎的髮病情況.分析不同年齡段患兒穿孔性闌尾炎主要臨床癥狀、體徵、實驗室及影像檢查的差異.結果 本院近20年共收治急性闌尾炎5859例,其中穿孔性闌尾炎1446例,男936例,女510例,男女比1.84∶1,總穿孔率為24.68％.不同年齡段患兒闌尾炎穿孔率分彆為:新生兒及嬰幼兒組28.65％,學齡前組28.63％,小學年齡組22.64％,青春期組13.35％.穿孔性闌尾炎髮病呈季節性分佈,其中夏季7、8、9三箇月髮病率最高,而2、3、4三箇月髮病率最低.腹痛是各年齡組最常見癥狀,各年齡組髮生率無明顯差異(P＞0.05).轉移性右下腹痛僅齣現于1 5.70％的患兒中,且隨年齡增長髮生率逐漸增加.髮熱、嘔吐、厭食、腹瀉等癥狀髮生率隨年齡增長逐漸降低,差異有統計學意義(P＜0.05).而轉移性右下腹痛和腹部壓痛及肌緊張的髮生率隨年齡增長逐漸升高,差異有統計學意義(P＜0.01).中性粒細胞比例新生兒及嬰幼兒組低于小學年齡組和青春期組,C反應蛋白水平新生兒及嬰幼兒組高于小學年齡組和青春期組,差異有統計學意義(P＜0.05).腹部平片和B型超聲顯示青春期組腸梗阻徵和腸壁增厚伴蠕動減少的髮生率高于其他各組,B型超聲和CT顯示小學年齡組和青春期組闌尾糞石齣現率高于新生兒及嬰幼兒組和學齡前組,差異有統計學意義(P＜0.05).結論 闌尾炎穿孔率隨年齡的變化而不同.穿孔性闌尾炎髮病呈季節性分佈.不同癥狀、體徵在不同年齡組的髮生率有顯著差異.不同年齡組患兒中性粒細胞比例和C反應蛋白不同.部分影像學錶現在不同年齡組患兒中齣現率不等.
목적 분석불동년령단인동급성천공성란미염류행병학화림상표현적차이,위개진급성천공성란미염적조기진단제공이론의거.방법 수집근20년본원수치적급성천공성란미염환인적림상자료.근거년령분위신생인급영유인조(1d지3세)、학령전조(4～7세)、소학년령조(8～12세)、청춘기조(13～16세).통계천공성란미염적성별비례화년령분포.계산비교불동년령단환인적천공솔.비교불동월빈불동년령단환인천공성란미염적발병정황.분석불동년령단환인천공성란미염주요림상증상、체정、실험실급영상검사적차이.결과 본원근20년공수치급성란미염5859례,기중천공성란미염1446례,남936례,녀510례,남녀비1.84∶1,총천공솔위24.68％.불동년령단환인란미염천공솔분별위:신생인급영유인조28.65％,학령전조28.63％,소학년령조22.64％,청춘기조13.35％.천공성란미염발병정계절성분포,기중하계7、8、9삼개월발병솔최고,이2、3、4삼개월발병솔최저.복통시각년령조최상견증상,각년령조발생솔무명현차이(P＞0.05).전이성우하복통부출현우1 5.70％적환인중,차수년령증장발생솔축점증가.발열、구토、염식、복사등증상발생솔수년령증장축점강저,차이유통계학의의(P＜0.05).이전이성우하복통화복부압통급기긴장적발생솔수년령증장축점승고,차이유통계학의의(P＜0.01).중성립세포비례신생인급영유인조저우소학년령조화청춘기조,C반응단백수평신생인급영유인조고우소학년령조화청춘기조,차이유통계학의의(P＜0.05).복부평편화B형초성현시청춘기조장경조정화장벽증후반연동감소적발생솔고우기타각조,B형초성화CT현시소학년령조화청춘기조란미분석출현솔고우신생인급영유인조화학령전조,차이유통계학의의(P＜0.05).결론 란미염천공솔수년령적변화이불동.천공성란미염발병정계절성분포.불동증상、체정재불동년령조적발생솔유현저차이.불동년령조환인중성립세포비례화C반응단백불동.부분영상학표현재불동년령조환인중출현솔불등.
Objective To examine the epidemiology and clinical features of perforated appendicitis (PA) in children by age group.Methods Medical charts of pediatric acute appendicitis (AP) patients hospitalized between January 1991 and December 2010 were retrospectively reviewed.All patients were divided into four age groups:group Ⅰ:1d-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 among 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 groups Ⅲ 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 leukocytosis varied significantly among four age groups (P ＞ 0.05).Neutrophil was significantly lower in group Ⅰ than that 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 Ⅱ-Ⅲ (P＜0.05).Fecaliths were more frequently observed in groups Ⅲ and Ⅳ (P＜0.05).Conclusions Younger pediatric patients have a higher risk of complicating PA,and also differ significantly from their older counterparts in terms of clinical features.
