Horwitz J R, Gursoy M, Jaksic T, Lally K P
Division of Pediatric Surgery, University of Texas Medical School, Houston, UK.
Am J Surg. 1997 Feb;173(2):80-2. doi: 10.1016/S0002-9610(96)00417-5.
Appendicitis is an uncommon diagnosis in very young children. It is frequently complicated by delays in diagnosis, perforation, and lengthy hospital stays.
To review our recent experience with appendicitis among children younger than 3 years old, and to identify the independent predictors of a prolonged hospital stay.
A retrospective case series review was performed on all children under age 3 who had an appendectomy for appendicitis between January 1983 and February 1994. Multiple regression analysis was used to identify the independent predictors of a prolonged hospital stay.
Sixty-three children were identified. Mean age was 2.2 years (range 11 to 35 months). The mean delay from onset of symptoms to presentation was 4.3 days. Fifty-seven percent were initially misdiagnosed. Diarrhea was reported in 33%. Perforation and/or gangrene were found in 84%. Perforation and/or gangrene at laparotomy and a history of diarrhea at presentation were independent predictors of a prolonged hospital stay.
Appendicitis in children under 3 years old is characterized by delays in diagnosis and perforation. A history of diarrhea is an important factor that confuses the diagnosis, prolongs the observation period, and delays appropriate therapy.
阑尾炎在幼儿中是一种不常见的诊断。它经常因诊断延迟、穿孔和住院时间延长而复杂化。
回顾我们近期在3岁以下儿童阑尾炎方面的经验，并确定住院时间延长的独立预测因素。
对1983年1月至1994年2月期间所有因阑尾炎接受阑尾切除术的3岁以下儿童进行回顾性病例系列研究。采用多元回归分析确定住院时间延长的独立预测因素。
共确定63例患儿。平均年龄2.2岁（范围11至35个月）。从症状出现到就诊的平均延迟时间为4.3天。57%的患儿最初被误诊。33%的患儿有腹泻症状。84%的患儿发现有穿孔和/或坏疽。剖腹手术时发现穿孔和/或坏疽以及就诊时有腹泻病史是住院时间延长的独立预测因素。
3岁以下儿童阑尾炎的特点是诊断延迟和穿孔。腹泻病史是一个重要因素，它会混淆诊断、延长观察期并延误适当治疗。
