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Objective:To investigate the application value of multi-slice spiral CT and abdominal ultrasound methods in the clinical diagnosis of acute appendicitis in children.Methods:We included 50 children patients who were pathologically diagnosed with acute appendicitis by the Department of Surgery, Dongyang Maternal and Child Health Hospital from August 2016 to August 2019. Before surgery, all patients underwent multi-slice spiral CT and abdominal ultrasound examinations. We recorded the time taken to complete multi-slice spiral CT and abdominal ultrasound examinations. Taking pathological results as the diagnosis criteria, we also calculated the coincidence rate of each imaging method.Results:The time we took to complete multi-slice spiral CT examination was shorter than that for abdominal ultrasound examination [(13.34 ± 3.86) minutes vs. (23.45 ± 4.77) minutes, t = 11.65, P < 0.05]. The coincidence rate of multi-slice spiral CT in identifying acute simple appendicitis, acute phlegmonous appendicitis, and acute gangrenous appendicitis was 95.24%, 95.00%, and 100.0%, respectively, and it was 71.73%, 70.00%, 88.89%, respectively for abdominal ultrasound examination. The coincidence rates in identifying acute simple appendicitis, acute phlegmonous appendicitis, and acute gangrenous appendicitis were significantly different between multi-slice spiral CT and abdominal ultrasound examinations ( χ2 = 4.29, 4.33, 1.06, all P < 0.05). Conclusion:Compared with abdominal ultrasound, multi-slice spiral CT is easier to operate, takes a shorter time in manipulation, provides more distinct images, and has a higher coincidence rate. Therefore, multi-slice spiral CT is of great diagnostic value for acute appendicitis in children.
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BACKGROUND: Enhanced recovery after surgery (ERAS), as a new concept in surgery, has dramatically changed the mode of perioperative treatment for children with acute appendicitis. METHODS: The retrieval strategy developed by the Cochrane Collaboration was conducted using the CNKI database, Wanfang Medical Network, PubMed, EBSCO, Medline, and Cochrane database by combining subject headings and free words. A review of the randomized controlled trials on the use of the ERAS concept in the perioperative treatment of acute appendicitis in children was conducted between the establishment of the database and May 15, 2021. Keywords included enhanced recovery after surgery, fast track surgery, ERAS, FTS, child, infant, and appendicitis. The quality of the literature was evaluated according to the RevMan 5.3 software provided by the Cochrane Collaboration. RESULTS: Five randomized controlled trials on ERAS in children with acute appendicitis were finally included. The heterogeneity of postoperative stay time was tested in 4 studies using continuous variables, with Chi-squared test (Chi2) =221.52, degree of freedom (df) =3, I2=99%>50%. An overall analysis using a random effects model showed that the ERAS group was significantly different compared to the control group [Z=5.26; mean difference (MD) =-1.65; 95% CI: -2.27 to -1.03; P<0.00001]. The heterogeneity of the readmission rate was tested in 5 studies using dichotomous variables, with Chi2=5.11, df =3, I2=41%<50%, P=0.91. Overall analysis using a fixed effects model showed no statistically significant difference between the ERAS group and the control group [Z=0.80; odds ratio (OR) =1.16; 95% CI: 0.81 to 1.66; P=0.42]. The heterogeneity of the recurrence rate was tested in 4 studies using dichotomous variables, with Chi2=3.73, df =3, I2=20%<50%, P=0.29. Overall analysis using a fixed effects model showed no statistically significant difference between the ERAS group and the control group (Z=1.14; OR =0.76; 95% CI: 0.47 to 1.22; P=0.26). DISCUSSION: The results of the meta-analysis confirmed that perioperative application of the ERAS concept in children with acute appendicitis can promote the rehabilitation of children, reduce the postoperative stay time, and reduce the readmission rate and reoperation rate.
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Objective To clarify diagnostic value of C-reactive protein (CRP) in the pathological types of acute appendicitis in children and the role of CRP as a surgical indication marker for appendicitis.Methods Two hundred and six patients who underwent appendectomies and had pathologically confirmed appendicitis were reviewed between January 2010 and February 2014,and they were divided into gangrenous appendicitis group(n =53) and non-gangrenous appendicitis group(n =153) by postoperative pathological type.The correlation between preoperative clinical factors and the actual histological severity,and identify surgical indication markers were assessed by multivariate analysis and ROC analysis.Results There were significant differences in white blood count(WBC),neutrophils percentage and CRP level between gangrenous appendicitis group and non-gangrenous appendicitis group(P ＜ 0.05).Multivariate analysis showed that the level of CRP should be a risk factor for judging gangrenous appendicitis.It showed that the role of CRP in judging gangrenous appendicitis was superior to the proportion of neutrophils and WBC in the ROC curve.The ROC curve showed that the area under the ROC curve for the CRP level,neutrophils percentage and WBC was 0.931,0.659 and 0.599 respectively,and the optimal cut off value of CRP for surgical indication for classifying cases was around 44.4 mg/L,and the sensitivity was 75.5 ％,specificity was 93.5 ％.Conclusion The level of CRP is useful in identifying the pathological types of acute appendicitis in children,and can be considered to be a surgical indication marker for acute appendicitis in children.
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PURPOSE: Acute appendicitis still remains one of the most common causes of childhood abdominal surgery. Despite of the development of modern diagnostic tools, it presents more serious problems than in adults due to the higher perforation rate. METHODS: In our hospital, 5-year term clinical reviews have been performed, over the last 2 decades to see if there were any changing tendencies of this disease entity. We reviewed 186 cases of child acute appendicitis between January 1997 and December 2001. RESULTS: The results were as follows: 1) The male to female ratio was 1.35: 1. 2) The peak incidence occurred in the 11 to 15 years old age group. 3) The overall perforation rate was 24.7%, which was decreased compared with 34.7% of our previous study (P<0.05, Odd ratio=0.60). 4) The negative exploration rate was 8.06%. 5) The overall complication rate were 2.85% and 32.6% in non-perforated and perforated cases, respectively. CONCLUSION: In conclusion, the incidence of acute appendicitis were shown to be almost the same as for the previous decade, but the perforation rate had dropped, maybe due to the early intervention, and advances in the diagnostic tools.
