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目的探讨新生儿急性阑尾炎的临床特点。方法对我院1980—2011年诊断的新生儿阑尾炎病例进行回顾性分析,腹部立位X线片提示消化道穿孔或B超提示阑尾穿孔者为穿孔组,其余为非穿孔组,总结两组患儿的临床特点。结果研究期间我科共收治新生儿急性阑尾炎患儿20例,其中非穿孔组12例,穿孔组8例。患儿表现为发热15例,拒乳、反应弱13例,腹胀10例,呕吐7例,血便3例;临床表现结合腹部超声诊断16例,入院后剖腹探查明确诊断4例,其中3例入院诊断消化道穿孔,1例诊断坏死性小肠结肠炎合并腹膜炎。穿孔组胃肠外营养时间和住院时间明显长于非穿孔组[(12.5±5.1)天比(6.0±3.3)天,(20.3±5.8)天比(14.0±5.0)天,P<0.05],两组胎龄、性别、体重、发病日龄、发病至诊断时间差异均无统计学意义(P>0.05)。20例患儿中经内科保守治疗11例,经手术治疗9例,17例治愈出院,1例好转出院,1例放弃治疗,1例死亡。结论新生儿阑尾炎缺乏特异性临床表现,需结合腹部X线、B超检查或剖腹探查明确诊断。穿孔患儿早期诊断困难,容易误诊。
Objective To investigate the clinical features of neonatal acute appendicitis. Methods The neonatal appendicitis cases diagnosed in our hospital from 1980 to 2011 were retrospectively analyzed. The abdominal position radiographs suggested that the perforation of the digestive tract or B-mode ultrasound showed that the perforation of the appendix was perforated and the rest were non-perforated. Children’s clinical features. Results During the study period, 20 children with acute appendicitis were admitted to our department. Among them, 12 were non-perforation and 8 perforation. Children showed fever in 15 cases, refused to milk, the reaction was weak in 13 cases, abdominal distension in 10 cases, vomiting in 7 cases, bloody stool in 3 cases; clinical manifestations combined with abdominal ultrasound in 16 cases, post-hospital laparotomy confirmed diagnosis of 4 cases, of which 3 were admitted Diagnosis of digestive tract perforation, 1 case of necrotizing enterocolitis with peritonitis. The time of parenteral nutrition and hospital stay in perforation group was significantly longer than that in non-perforation group [(12.5 ± 5.1) days vs (6.0 ± 3.3 days), (20.3 ± 5.8 days vs 14.0 ± 5.0 days, P <0.05] There was no significant difference in gestational age, sex, body weight, age of onset, onset time to diagnosis (P> 0.05). Of the 20 children, 11 were conservatively treated by internal medicine, 9 were surgically treated, 17 were cured, 1 were discharged, 1 was abandoned and 1 died. Conclusion Neonatal appendicitis lack of specific clinical manifestations, need to be combined with abdominal X-ray, B-ultrasound or laparotomy clear diagnosis. Early diagnosis of perforation in children with difficulty, easy to misdiagnosis.