| Background:Acute appendicitis is one of the most common causes of abdominal pain in children,and approximately 20-30%of children with acute abdominal pain referred to paediatric surgical services have acute appendicitis.Fecalith causes luminal obstruction of the appendix,leading to distention and increased pressure within the lumen,followed by ischemic changes in the appendiceal mucosa and bacterial invasion,which are the main causes of acute appendicitis.The young age of the children,poor communication skills,and atypical clinical presentation made diagnosis difficult.Ultrasonography and Computed Tomography are the most frequently used diagnostic methods for acute appendicitis.Some scholars have stated recently that magnetic resonance imaging can be used for the evaluation of appendicitis in children.The optimal therapeutic strategy for children with acute appendicitis is appendectomy.As the field of immunology and microbiology continues to evolve and mature,research demonstrate that the appendix may be an important component of intestine mucosal immunity and the balance of intestinal flora.This classic therapeutic treatment is somehow inducing postoperative complications,including wound infection,intra-abdominal infection,bleeding and intestinal obstruction.In addition,The present study shows that the negative appendectomy rate ranged from 5.4%to 17.6%.In recent years,there have been more and more studies on preserving appendix.Liu et al established a new therapeutic strategy-endoscopic retrograde appendicitis therapy for acute uncomplicated appendicitis in 2012,which is defined to relieve the obstruction,decrease intraluminal pressures and resolve inflammation by movements such endoscopic appendiceal intubation,appendiceal decompression,retrograde appendicography,stent drainage.At present,ERAT has been successfully used for the treatment of acute appendicitis in adults.However,the feasibility and safety of this approach in children has not been demonstrated.Objective:The objective of this study was to explore the clinical data of children with acute uncomplicated appendicitis,compare the clinical effect of endoscopic retrograde appendicitis therapy and laparoscopic appendectomy and analysis the intraoperative conditions of endoscopic retrograde appendicitis therapy,in order to provide reference for improving clinical diagnosis and treatment.Methods and materials:The clinical data of 60 children with acute uncomplicated appendicitis admitted in our hospital from October 2019 to June 2021 were collected;30 cases were managed endoscopic retrograde appendicitis therapy,and 30 cases were received laparoscopic appendectomy.Findings of acute appendicitis including colonoscopic imaging and endoscopic retrograde appendicography imaging were analyzed.Two groups were compared with regards to general data,operative duration,initial feeding time,postoperative WBC count,postoperative hospital stay,the hospitalization costs and complications.The statistic was performed by statistical software SPSS 25.0.P<0.05 was considered statistically significant.Results:The operation was completed successfully in 60 patients.The success rate of cannulation for ERAT was 100%.The mean duration of surgery in the ERAT group was 43.57±12.97 minutes,and that in the LA group was 53.43±9.08 minutes.The mean duration of surgery in the ERAT group were significantly shorter than they were in the LA group(P=0.001).The average eating time in the ERAT group was 6.80±2.02 hours,and that in the LA group was 12.33±2.01 hours.The average eating time in the ERAT group were significantly earlier than they were in the LA group(P<0.001).The postoperative WBC count in the ERAT group was(6.51±1.53)×10~9/L,and that in the LA group was(7.42±1.61)×10~9/L.The postoperative WBC count in the ERAT group were significantly lower than they were in the LA group(P=0.029).The postoperative hospital stay in the ERAT group was 3.20±1.34 days,and that in the LA group was 5.03±1.30 days.The postoperative hospital stay in the ERAT group were significantly shorter than they were in the LA group(P<0.001).The hospitalization costs in the ERAT group was 6990±1451 yuan,and that in the LA group was 12132±1508 yuan.The hospitalization costs in the ERAT group were significantly lower than they were in the LA group(P<0.001).25 patients with intraluminal appendicoliths were removed successfully in ERAT group.The rate of recurrence in the ERAT group was 6%and no complication occurred during the follow-up during the follow-up.The complication rate of LA was 10%.Conclusion:ERAT is effective for the treatment of children with acute uncomplicated appendicitis and can significantly shorten the postoperative hospital stay of children,with minimal invasiveness,no scars,quick recovery and low complications. |
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