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儿童急性阑尾炎：临床表现与诊断

Author
David E Wesson, MD
Section Editor
Jonathan I Singer, MD
Deputy Editor
James F Wiley, II, MD, MPH
Translators
陈杰, 副主任医师

引言

阑尾炎是儿童急诊腹部手术中最常见的疾病。获得成功结局的关键是在阑尾发生坏疽或穿孔前早期诊断和及时行阑尾切除术。

相比于较年幼儿童，大龄儿童及青少年更常发生阑尾炎，并且其临床特征往往与成人阑尾炎相似。而对于较年幼的儿童，因为其临床表现可能为非特异性的、症状不能充分表现出来，以及患儿往往焦虑不安与不适，使得很难进行评估，所以阑尾炎的诊断特别困难。在进行阑尾炎评估的特定儿童中，实验室检测和影像学检查是有用的辅助手段，影像学检查主要为超声(ultrasound, US)和计算机断层扫描(computed tomography, CT)或磁共振成像(magnetic resonance imaging, MRI)。

本专题将讨论儿童急性阑尾炎的流行病学、临床特征，以及对疑似阑尾炎儿童的评估。关于儿童阑尾炎诊断性影像学检查和治疗的详细讨论参见其他专题。 (参见“儿童急性阑尾炎：诊断成像”和“儿童急性阑尾炎的处理”)

解剖学

阑尾起自盲肠，大多数儿童的阑尾位于右下腹(right lower quadrant, RLQ)。在先天性肠道位置异常(如，未经矫正的肠旋转不良)、全内脏反位的儿童中，以及膈疝、腹裂和脐膨出修复术后，阑尾可以位于上腹部或腹腔左侧[1]。

阑尾的一些解剖学特点可能在整个儿童期阑尾炎的发生率及表现方面有一定作用。这些包括以下方面[2]：

                           

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-03.
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