Okamoto Tatsuya, Sano Kaoru, Ogasahara Keizo
Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakura-dai, Sama-ku, Kobe, 654-0081, Japan.
Surg Today. 2006;36(6):515-8. doi: 10.1007/s00595-006-3189-6.
To assess the diagnostic value of the white blood cell count (WBC) and serum C-reactive protein (CRP) level in children with advanced appendicitis.
We reviewed 289 children ranging in age from 3 to 15 years old, who underwent appendectomy in our hospital between 1993 and 2003. The advanced appendicitis group consisted of patients with associated perforation, abscess formation, or purulent ascites, and the simple appendicitis group consisted of patients who underwent uncomplicated appendectomy. We compared the age, sex, duration of abdominal pain before surgery, preoperative WBC and CRP level, and hospital stay in the two groups. We analyzed the diagnostic value of WBC and CRP level using a receiver-operating characteristic (ROC) curve.
The children in the advanced appendicitis group had a significantly longer duration of pain, a higher serum CRP level, and longer hospitalization than those in the simple group. The serum CRP levels had good diagnostic value in differentiating between the advanced and simple groups. Both the CRP level and the WBC in the patients who suffered abdominal pain for longer than 48 h before surgery had diagnostic value in differentiating between the advanced and simple groups.
These findings suggest that increased values of CRP and WBC more than 48 h after the onset of acute abdominal symptoms are indicators of advanced appendicitis.
评估白细胞计数（WBC）和血清C反应蛋白（CRP）水平对小儿复杂性阑尾炎的诊断价值。
回顾性分析1993年至2003年间在我院行阑尾切除术的289例3至15岁儿童的临床资料。复杂性阑尾炎组包括伴有穿孔、脓肿形成或脓性腹水的患者，单纯性阑尾炎组包括行单纯阑尾切除术的患者。比较两组患者的年龄、性别、术前腹痛持续时间、术前WBC和CRP水平以及住院时间。采用受试者工作特征（ROC）曲线分析WBC和CRP水平的诊断价值。
复杂性阑尾炎组患儿的疼痛持续时间明显长于单纯性阑尾炎组，血清CRP水平更高，住院时间更长。血清CRP水平对鉴别复杂性阑尾炎组和单纯性阑尾炎组具有良好的诊断价值。术前腹痛超过48小时的患者，其CRP水平和WBC对鉴别复杂性阑尾炎组和单纯性阑尾炎组均具有诊断价值。
这些结果表明，急性腹痛症状出现48小时后CRP和WBC值升高是复杂性阑尾炎的指标。
