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  • Title: [Therapeutic effectiveness of modified endoscopic retrograde appendicitis therapy for acute appendicitis of different severities in children].
    Author: Zhang AD, Zhang YL, Wang MZ, Song YP, Lin Y, Zeng LC, Wang CH, Guo HW, Fan N, Wang BX, Jiang X.
    Journal: Zhonghua Er Ke Za Zhi; 2024 Jul 02; 62(7):636-642. PubMed ID: 38955681.
    Abstract:
    Objective: To investigate the effects of modified endoscopic retrograde appendicitis therapy (mERAT) on the treatment of children with different severities of acute appendicitis. Methods: This study was a case-control study. A total of 586 children with acute appendicitis, who were admitted to the Pediatric Department of Second Affiliated Hospital of Air Force Medical University between January 2019 and November 2023, were selected as the research subjects. According to the severity of the disease, the patients were divided into simple appendicitis group, suppurative appendicitis group and perforated appendicitis group. The baseline data, hospitalization treatment and costs, outcomes, and recurrence in each group were analyzed, and the difference in the effectiveness of mERAT between the groups were compared by Kruskal-Wallis H test and χ2 test. Results: Among 586 children, there were 338 males and 248 females. The age at onset was 7.0 (4.6, 9.4) years. There were 475 cases of simple appendicitis, 78 cases of suppurative appendicitis, and 33 cases of perforated appendicitis. There were no significant differences in age and gender among the three groups (F=0.59, χ2=3.31, both P>0.05). However, there were statistically significant differences in body temperature, white blood cell counts, neutrophil percentage, lymphocyte percentage, nausea or vomiting, right lower abdominal pain, umbilical pain, right lower abdominal tenderness, and right lower abdominal rebound pain (H=7.56, 161.52, 169.11, and 169.61, χ2=12.05, 13.82, 12.05, 7.74, 20.35, and 94.61, all P<0.05). Also, the treatment time, postoperative hospital stay, total hospital stay, and cost showed statistically significant differences (H=4.70, 33.66, 34.99, 30.37, all P<0.05). There was no significant difference in the initial treatment success rate (98.1% (466/475) vs. 98.7% (77/78) vs. 90.9% (30/33), P=0.057). During the 30 (23, 36) months of follow-up, the recurrence rate was 7.9% (35/433) in the simple appendicitis group, 20.8% (15/72) in the suppurative appendicitis group, and 30.0% (9/30) in the perforated appendicitis group, with a statistically significant difference (χ2=23.56, P<0.001). Among the children with recurrent appendicitis, 15 cases still chose mERAT, of them 11 cases (31.2%) had simple appendicitis, 2 cases (2/15) had suppurative appendicitis, and 2 cases (2/9) had perforated appendicitis.The latest time to recurrence in the 3 groups was 32, 35 and 10 months, respectively. Conclusion: Treatment with mERAT has a good effect in pediatric simple appendicitis, but has a higher recurrence rate despite a better initial treatment success rate in suppurative appendicitis and perforated appendicitis. 目的： 探讨改良内镜下逆行阑尾炎治疗术（mERAT）对儿童不同严重程度急性阑尾炎的治疗效果。 方法： 病例对照研究。选择2019年1月至2023年11月经空军军医大学第二附属医院儿科收治的586例急性阑尾炎患儿为研究对象。按照疾病严重程度将患儿分为单纯性阑尾炎组、化脓性阑尾炎组和阑尾穿孔组。分析各组患儿的基线资料、住院诊治情况、住院费用、治疗效果和复发后治疗情况，并比较mERAT在各组间疗效的差异。采用Kruskal-Wallis H检验和χ2检验进行组间比较。 结果： 586例阑尾炎患儿中男338例、女248例，发病年龄7.0（4.6，9.4）岁。单纯性阑尾炎组475例，化脓性阑尾炎组78例，阑尾穿孔组33例。三组患儿在年龄、性别上差异均无统计学意义（F=0.59，χ2=3.31，均P>0.05）。在体温、白细胞计数、中性粒细胞百分比、淋巴细胞百分比、恶心呕吐、右下腹痛、脐周痛、右下腹压痛、右下腹反跳痛方面，差异均有统计学意义（H=7.56、161.52、169.11、169.61，χ2=12.05、13.82、12.05、7.74、20.35、94.61，均P<0.05）。三组患儿在治疗时间、术后住院时间、总住院时间、治疗费用方面差异均有统计学意义（H=4.70、33.66、34.99、30.37，均P<0.05）。三组患儿在接受治疗后，起始治疗成功率分别为98.1%（466/475）、98.7%（77/78）、90.9%（30/33），差异无统计学意义（P=0.057）。随访时间30（23，36）个月，单纯性阑尾炎的复发率为7.9%（35/443），化脓性阑尾炎组和阑尾穿孔组分别为20.8%（15/72）和30.0%（9/30），三组复发率差异有统计学意义（χ2=23.56，P<0.001）。三组复发患儿在复发后仍分别有11例（31.4%），2例（2/15），2例（2/9）患儿再次选择mERAT，且三组患儿的复发时间最长的分别为32、35、10个月。 结论： mERAT对于儿童单纯性阑尾炎的治疗具有良好的效果，但对于化脓性阑尾炎和阑尾穿孔的治疗虽有较高的起始治疗成功率，但复发率较高。.
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