| BackgroundAcute appendicitis(AA)is one of the common causes for children to visit the emergency department,accounting for 1% to 2% of the number of pediatric surgical admissions.AA includes acute uncomplicated appendicitis(AUA)and acute complicated appendicitis(ACA).The pooled incidence of appendicitis in the world is 100-151 /100,000 person-years,and its incidence is on the rise in emerging industrialized countries.Prior to Professor Liu Bingrong reported on the treatment of AA with endoscopic retrograde appendicitis therapy(ERAT),traditional treatments for AA included appendectomy and antibiotic therapy.ERAT was initially used to treat AUA,and then the results of related studies on ERAT gradually increased,and it was used in the treatment of periappendiceal abscess and colonoscopic appendectomy.Its safety and effectiveness have been confirmed.However,in the operation of ERAT,X-rays are needed to monitor the contrast.Considering the possible adverse effects of X-ray radiation on children and the high requirements of ERAT for the operation room(the wall needs special treatment to prevent radiation leakage),the pediatric endoscopy team and the ultrasound diagnosis department of our hospital cooperated to improve it.It was the first time in the world to use ultrasound instead of X-ray to monitor the position of appendicitis and stent,forming modified retrograde appendicitis therapy(m ERAT).The purpose of this study was to investigate the efficacy of m ERAT in the treatment of AUA in children.ObjectiveBy analyzing the clinical data and follow-up results of m ERAT in the treatment of AUA in children,the efficacy and safety of m ERAT were discussed,and compared with antibiotic therapy or laparoscopic appendectomy(LA)to evaluate the difference of therapeutic effect,so as to provide evidence support for the promotion of m ERAT.MethodUnder the review of the Ethics Committee of Tangdu Hospital of Air Force Military Medical University(202106-20),the clinical data of children with AUA who were admitted to the Department of Pediatrics and General Surgery of our hospital from October 2018 to May 2021 and met the inclusion and exclusion criteria were retrospectively collected through the electronic case system and case report form.According to the treatment methods,they were divided into m ERAT group,antibiotic treatment group and LA group.From June 9 to 17,2022,the patients were followed up by telephone and combined with the outpatient and inpatient electronic information system to summarize the recurrence within 1 year after discharge.The first part analyzed the clinical data and follow-up results of the m ERAT group,summarized the initial treatment success rate,recurrence rate,incidence of adverse events and so on,and introduced the operation methods and relevant experience of m ERAT.In the second and third parts,based on the first part,the efficacy of m ERAT and antibiotics,m ERAT and LA in the treatment of AUA in children were compared respectively,and the differences in therapeutic effects were evaluated.Result1.A total of 389 children who met the inclusion and exclusion criteria were included in our study.There were 228 patients in the m ERAT group,127 males(55.7%),aged 6.2(3.9,8.6)years;There were 95 cases in the antibiotic group,46 of whom were male(48.4%),aged 5.4(4.1,7.8)years;In the LA group,there were 66 cases,47 males(71.2%),aged 10.1(8.2,12.4)years old.2.The success rate of intubation and treatment in m ERAT group was 96.9 %(221/228)and 96.9 %(221/228),respectively.The operation time was 40.0(36.0,45.0)min,the stent implantation rate was 83.3 %(184/221),the self-shedding rate of stent was48.4 %(89/184),the total hospitalization time was 3(3,4)days,the postoperative hospitalization time was 2(1,3)days,the total hospitalization cost was 12787.0(11770.1,13585.5)yuan,the incidence of adverse events during hospitalization was 3.5 %(8/228),and the recurrence rate within 1 year after discharge was 6.9 %(14/204).3.In the antibiotic group,the initial treatment success rate was 81.1 %(77/95),the total hospitalization time was 4(3,6)days,the hospitalization cost was 3357.2(2576.2,4302.1)yuan,the recurrence rate was 16.4 %(12/73),and the incidence of adverse events was 22.1%(21/95).Univariate analysis showed that there were statistical differences in the initial treatment success rate,total hospitalization time,hospitalization cost,recurrence rate and incidence of adverse events during hospitalization between the m ERAT group and the antibiotic group(P<0.05).After adjusting for potential confounding factors by multivariate analysis,the effect of treatment on the success rate of initial treatment was statistically different(m ERAT vs antibiotic,OR=10.34,95% CI 3.78 to 28.29,P<0.001),and the effect on the recurrence rate was statistically different(m ERAT vs antibiotic,OR=0.30,95% CI 0.12 to 0.72,P=0.01).There were statistically significant difference in the incidence of adverse events(m ERAT vs antibiotics,OR=0.08,95% CI 0.03 to 0.21,P<0.001)and hospitalization costs(m ERAT vs antibiotics,β=8530.55,95% CI 7890.90 to 9170.19,P<0.001),and the impact on total hospital stay(m ERAT vs antibiotic,β=-0.74,95% CI-1.19 to-0.28,P=0.002).4.In LA group,the initial treatment success rate was 100%(66/66),the recurrence rate was 1.7%(1/58),the operation time was 65.0(55.0,85.5)min,the total hospital stay was 6.0(4.0,7.3)days,the postoperative hospital stay was 5.0(3.8,6.0)days,the hospitalization cost was 18996.4(16094.5,20588.1)yuan,and the incidence of adverse events was 6.1%(4/66).Univariate analysis showed that there was no significant difference in the initial treatment success rate,recurrence rate,and incidence of adverse events between the m ERAT group and the LA group.There were statistical differences in operation time,total hospital stay,postoperative hospital stay,and hospitalization costs(P<0.05).After adjusting for potential confounding bias by multivariate analysis,there was no statistically significant difference in the effect of treatment on the initial treatment success rate(m ERAT vs LA,OR<0.001,P=0.997),on the recurrence rate(m ERAT vs LA,OR=4.60,95% CI 0.53 to 39.90,P=0.17).and on the incidence of adverse events(m ERAT vs LA,OR=0.67,95% CI 0.16 to 2.80,P=0.58),but there were statistically significant difference in the operation time(m ERAT vs LA,β=-25.87,95% CI-30.85 to-20.89,P<0.001)and on hospitalization cost(m ERAT vs LA,β=-5933.88,95% CI-6760.71 to-5107.05,P<0.001).There were a statistically significant difference in the total length of stay(m ERAT vs LA,β=-2.20,95% CI-2.83 to-1.57,P<0.001)and on postoperative hospital stay(m ERAT vs LA,β=-2.26,95% CI-2.80 to-1.71,P<0.001).Conclusion1.m ERAT is safe and effective in the treatment of AUA in children,and has a broad application prospect.2.The efficacy and safety of m ERAT in the treatment of AUA in children are superior to antibiotics,and it is another choice for the treatment of appendix retention.3.Compared with LA,m ERAT has shorter operation time,lower cost and shorter hospitalization time.It is an effective appendix-preserving method for the treatment of AUA in children. |
PDF Full Text Request