孩子肚子痛,什么时候要注意阑尾炎?
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儿童阑尾炎最常发生在10岁左右;
饭后蹦跶不会导致阑尾炎; 儿童阑尾炎的典型症状包括:转移性右下腹疼痛和发烧。但只有不到一半的儿童会出现典型的临床症状,其他患儿需要医生进一步查体和辅助检查; 阑尾炎首选的临床检查是超声; 目前,腹腔镜的微创手术占到阑尾炎手术的90%。
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人的一生中患阑尾炎的风险是7%到8%[2]; 0-4岁儿童的年发病率为1-6/10000[3]; 14岁以下儿童的年发病率增至19-28/10000[3]; 最常发生于10岁左右的儿童; 男孩比女孩高发,比例为1.4:1。
早期厌食和肚脐周围的疼痛; 症状出现的24小时内向右下腹转移的疼痛,右下腹压痛; 随着时间的延迟出现呕吐、体温的增高以及腹痛的进一步加剧。
年龄>6岁; 腹痛持续<48小时; 白细胞计数≤18×10^9/L; C反应蛋白水平正常; 影像学检查显示无阑尾结石; 影像学检查显示阑尾直径≤1.1cm; 阑尾未破裂。
医学校对:小儿外科苏嘉鸿医生
参考资料:
1. St Peter SD, Sharp SW, Holcomb GW III, et al. An evidence-based definition for perforated appendicitis derived from a prospective randomized trial. J Pediatr Surg 2008;43(12):2242–5.
2. Addiss DG, Shaffer N, Fowler BS, et al. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990;132(5):910–25.
3. Anderson JE, Bickler SW, Chang DC, Talamini MA. Examining a common disease with unknown etiology: trends in epidemiology and surgical management of appendicitis in California, 1995-2009. World J Surg 2012; 36:2787.
4. Rabah R. Pathology of the appendix in children: an institutional experience and review of the literature. Pediatr Radiol 2007; 37:15.
5. Minneci PC, Hade EM, Lawrence AE, et al. Association of Nonoperative Management Using Antibiotic Therapy vs Laparoscopic Appendectomy With Treatment Success and Disability Days in Children With Uncomplicated Appendicitis. JAMA 2020; 324:581
6. Dunn JCY. Appendicitis. In: Pediatric Surgery, Coran AG, Adzick NS, Krummel TM, et al (Eds), Elsevier, Philadelphia 2012. p.1255.
7. Gorter RR, van Amstel P, van der Lee JH, et al. Unexpected findings after surgery for suspected appendicitis rarely change treatment in pediatric patients; Results from a cohort study. J Pediatr Surg 2017; 52:1269.
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