Differences Of Clinical Characteristics Between Acute Uncomplicated And Complicated Appendicitis In Children

Objectives: To investigate the effect of nonsurgical treatment in children with uncomplicated appendicitis and the efficacy of clinical manifestations combined with changes in the levels of inflammatory factors in differentiating acute uncomplicated from complicated appendicitis.Methods:1.To collect the clinical data of children diagnosed with "acute appendicitis " from June 2012 to December 2020 in the Department of pediatric surgery,the First Affiliated Hospital of Dali University.Children with primary diagnosis of acute uncomplicated appendicitis were selected based on disease course,clinical presentation,signs,and imaging examination.Children receiving surgical treatment whose pathological results were uncomplicated appendicitis were selected and compared with those receiving nonsurgical treatment to explore the efficacy of nonsurgical treatment in children with uncomplicated appendicitis.2.All the above children who underwent surgery were divided into acute complicated appendicitis group and acute uncomplicated appendicitis group based on pathological diagnosis,and the differences of clinical data including clinical manifestations,signs,laboratory tests and imaging studies between the two groups were compared.3.Thirty children diagnosed with acute appendicitis undergoing surgery at the Department of pediatric surgery of the First Affiliated Hospital of Dali University between December 2021 and December 2022 were selected as the observation group,while 12 children hospitalized due to noninflammatory diseases during the same period were randomly selected as the blank control group and the serum levels of IL-6,IL-10,IFN-γ And TNF-α were measured to analyze the diagnostic efficacy of the examined cytokines for complicated appendicitis.Results:105 patients from a total of 375 patients were initially diagnosed with uncomplicated appendicitis.42 cases were diagnosed as acute uncomplicated appendicitis after operation,and 28 children received conservative treatment.There was no significant difference in the length of hospital stay between the children receiving surgical treatment(n=42)and those receiving nonsurgical treatment(n=28)(p>0.05),but the total hospitalization cost in the surgical treatment group was higher than that in the nonsurgical treatment group(p<0.05).In the nonsurgical treatment group,23 patients were clinically cured(23 / 28,82.1%),2 patients were clinically improved(2 / 28,7.1%),and 3 patients crossed over to surgical treatment due to without effect(3 / 28,10.8%).In a follow-up of 25 patients who responded to nonsurgical treatment,acute appendicitis recurred in the follow-up period in 5 patients(5 / 25,20.0%),1 patient(1 / 25,4.0%)underwent appendicectomy,and 4 patients(4 / 25,16.0%)recovered after conservative treatment.350 children were operated on from 375,there was no significant difference in the course of disease between uncomplicated appendicitis group(n = 122)and complicated appendicitis group(n = 228)(P > 0.05),children with complicated appendicitis were relatively younger,had more comorbid vomiting,more boys,lower serum sodium ion concentrations and hemoglobin concentrations than children with uncomplicated appendicitis.Male gender,comorbid vomiting were independent risk factors for the appearance of complicated appendicitis;Hemoglobin concentration had low diagnostic efficacy for complicated appendicitis(AUC 0.61 ± 0.03),age,Alvarado score as well as multivariate combined diagnosis all had moderate diagnostic accuracy for complicated appendicitis(AUC 0.84 ± 0.02),and the area under the ROC curve of multivariate combined diagnosis was larger than other indicators,with statistically significant differences.3.Serum IL-6,IL-10,TNF-α、IFN-γ in patients with acute appendicitis(n = 30)the concentrations of all inflammatory factors were higher in patients with noninflammatory disease(n = 12),and the levels of each inflammatory factor were higher in the group with acute complicated appendicitis(n = 14)than in the group with uncomplicated appendicitis(n = 16)(P < 0.05).Conclusions: 1.Non operative treatment to acute uncomplicated appendicitis is safe and effective,and surgical treatment is required for acute complicated appendicitis;2.Clinical manifestations combined with the level of inflammatory factors can improve the correct rate of acute complicated appendicitis diagnosis.