| Objective:From April 1,2016 to November 30,2017,the clinical records of children with acute appendicitis in pediatric surgery at our hospital were analyzed by using retrospective survey method.Their clinical features,bacterialogy,and drug sensitivity were also observed.The aim of the study is to improve the early diagnosis rate of acute appendicitis in children and to guide rational selection of sensitive antibiotics,to reduce the incidence of postoperative complications and to accelerate the recovery of children with postoperative complications.Methods:Children's clinical data of acute appendicitis included age,sex,time from onset to treatment,fever,gastrointestinal symptoms,abdominal pain,tenderness,rebound tenderness,white blood cell count,percentage of neutrophils,C-reactive protein,color ultrasound,drug-sensitive test,the application of antibiotics,postoperative complications and outcomes.Results:1.One hundred and thirty-five case included 85 males and 50 females.The ratio of male to female is 1.7:1.The average age is 7 years and 4 months.Nine cases were under 3 years of age(6.67%);3 to 6 years of age,37 cases(27.41%);6 to 9 years of age,37 cases(27.41%);9 to 12 years,30 cases(22.21%);over 12 years old,22 cases(16.30%).2.The clinical manifestations of acute appendicitis in children were mainly consisted of abdominal pain(97.8%)?nausea and vomiting(85.2%)and fever(79.3%),following by diarrhea(15.6%)and abdominal distension(5.2%).Abdominal tenderness(94.1%),rebound tenderness(78.5%),and muscle tension(81.5%)are associated with a higher incidence of peritonitis.3.There are 114 children(84.5%)with elevated white blood cell count,116(85.9%)and neutrophil percentage over 70%.One hundred and six cases whose CRP were monitored were elevated 90(84.9%);One hundred and thirty two cases who were received abdominal ultrasound examination,122 had abnormal ultrasound findings,the positive rate is 92.4%.4.All the patients were underwent surgical treatment.Laparoscopic appendectomy was used in 124 cases,accounting for 91.8%.Conventional appendectomy was used in 7 cases,accounting for 5.2%,and other 4 cases were initially underwent laparoscopic appendectomy then transferred to open surgery,accounting for 3.0%.Postoperative pathological findings showed that simple appendicitis in 9 cases,accounting for 6.7%,suppurative appendicitis in 43 cases,accounting for 31.8%,gangrenous appendicitis in 69 cases,accounting for 51.1%,14 cases of periappendiceal abscess,accounting for 10.4%.Among them,there are 27 cases with appendix fecalith,accounting for 20%,appendix perforation in 21 cases,the perforation rate is 15.6%.There is no significant difference in the incidence of different pathological results between each course of disease.There is no significant difference in perforation rate of appendix between each course of disease.5.The positive rate of bacterial culture of pus is 78.9%.Gram-negative bacteria accounted for 97.1%,much higher than 2.9%of Gram-positive bacteria.The top three pathogenic bacteria are Escherichia coli(64.7%),Pseudomonas aeruginosa(15.7%),Klebsiella pneumoniae Pneumonia(5.9%).The most sensitive antibiotics are amikacin,meropenem,ticarcillin/clavulanic acid,cefoperazone/sulbactam,imipenem,piperacillin/tazobactam,the sensitivity rate?83.3%.6.The cure rate of this group is 100%.There are 12 cases whose sufferred from postoperative complications,accounting for 8.9%,including incision infection in 7 cases,fat liquefaction in 1 case,adhesive intestinal obstruction in 2 cases,abdominal abscess in 2 cases.Conclusion:Acute appendicitis in children more common in male than female.The incidence of this disease under 3 years old was significantly lower than that of over 3 years of age groups.The main clinical symptoms is abdominal pain,nausea and vomiting,high fever.The typical symptoms of transfer right lower quadrant pain is low.In physical examination,abdominal tenderness,rebound tenderness were in a higher proportion.Acute appendicitis in children is under rapidly progress.Gram-negative bacteria are the main pathogens,the most common is Escherichia coli.Antimicrobial resistance rate is high,Therefore,the bacterial culture testing,rational antibiotics use should be paid much attention in management of acute appendicitis in children. |
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