Akūta apendicīta neķirurģiska un ķirurģiska ārstēšana bērniem : pēdējo 5 gadu literatūras apraksts un klīniskie gadījumi
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Date
2021
Authors
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Journal ISSN
Volume Title
Publisher
Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Akūts apendicīts ir biežākā akūtā, neatliekamā ķirurģiskā pataloģija bērniem. 1%-8% bērniem ar sāpēm vēderā tiek apstiprināts akūts apendicīts. Akūts apendicīts visbiežāk sastopams vecuma grupā no 10 līdz 20 gadiem, bet var gadīties jebkurā vecumā.
Darba ietvaros apskatīti 70 literatūras avoti un tiek secināts, ka pēdējo gadu laikā akūta apendicīta incidence samazinājās, tomēr palielinājās perforāciju incidence. Akūtam apendicītam tiek novērota sezonāla ietekme, vasaras mēnešos incidence pieaug, bet cēlonis tam nav skaidrs. Darba ietvaros secināts, ka infekcijai ir būtiska loma akūta apendicīta patoģenēzē, apendicīta agrīnā stadijā dominē aerobie organismi, savukārt vēlīnā apendicīta stadijā biežāk ir sastopamas jaukta tipa kolonijas. Gangrenozā un perforētā apendicītā biežāk sastopamie organismi ir Escherichia coli. Bērniem, kuriem ir racionāls šķiedrvielu patēriņš, ir mazāka akūta apendicīta incidence nekā bērniem, kuri uzturā izmanto maz šķiedrvielu. Anatomiskas īpatnības ļoti korelē ar klīnisku ainu un var izraisīt diagnostikas sarežģītības un katrā vecumu grupā ir īpatnības klīniskā ziņā. Darbā tiek apskatītas biežākās kļūdainās diferenciālās diagnozes un kļūdainās diagnozes. Apskatītas diagnostikas nianses. Analizēta un aprakstīta ķirurģiskā ārstēšana un preoperatīvā sagatavošana.
Apkopojot informāciju, neķirurģiska ārstēšana ir relatīvi droša ārstēšana bērniem ar labu efektivitāti, ja klīniski, laboratoriski un galvenokārt radioloģiski apstiprināta diagnoze: akūts nekomplicēts apendicīts. Neķirurģiska terapija sevī iekļauj: analgēziju, adekvātu rehidratāciju un plaša spektra antibakteriālo terapiju (vidēji 7 dienas). Pēc neķirurģiskas ārstēšanas sākšanas lēmumu par tālāko taktiku jāpieņem ne vēlāk kā 24 h laikā. Hospitalizācijas laiks ķirurģiski un neķirurģiski ārstētiem pacientiem būtiski neatšķiras un pārsvarā atkārtotas hospitalizācijas tiek saistītas ar pacientu bažām. Neķirurģiska ārstēšana ir laba alternatīva, lai izvairītos no pēcoperāciju komplikācijām.
Acute appendicitis is the most common acute, urgent surgical pathology in children. Acute appendicitis is confirmed in 1%-8% of children with abdominal pain. Acute appendicitis is most common in the age group of 10 to 20 years but can occur at any age. The study reviews 70 literature sources and concludes that the incidence of acute appendicitis has decreased in recent years, but the incidence of perforations has increased. Acute appendicitis has a seasonal effect, the incidence increases in the summer months, but the cause is unclear. The study concluded that the pathogenesis of acute appendicitis plays an important role in the infection, aerobic organisms predominate in the early stage of appendicitis, while mixed colonies are more common in the late stage of appendicitis. The most common organisms in gangrenous and perforated appendicitis are Escherichia coli. Children with rational fiber intake have a lower incidence of acute appendicitis than children who consume less fiber. Anatomical features are highly correlated with the clinical picture and can lead to diagnostic difficulties and there are features of clinical knowledge in each age group. The most common erroneous differential diagnoses and erroneous diagnoses are considered in the study. Diagnostic nuances are discussed. Surgical treatment and preoperative preparation are analysed and described. Taken together, nonsurgical treatment is a relatively safe treatment for children with good efficacy if the diagnosis is confirmed clinically, laboratory and mainly radiologically: acute uncomplicated appendicitis. Nonsurgical therapy includes: analgesia, adequate rehydration, and broad-spectrum antibacterial therapy (average 7 days). After starting nonsurgical treatment, a decision on further tactics should be made within 24 hours at the latest. Hospitalization times for surgically and conservatively treated patients do not differ significantly, and predominantly repeated hospitalizations are associated with patient concerns. A nonsurgical treatment is a good alternative to avoid a postoperative complications.
Acute appendicitis is the most common acute, urgent surgical pathology in children. Acute appendicitis is confirmed in 1%-8% of children with abdominal pain. Acute appendicitis is most common in the age group of 10 to 20 years but can occur at any age. The study reviews 70 literature sources and concludes that the incidence of acute appendicitis has decreased in recent years, but the incidence of perforations has increased. Acute appendicitis has a seasonal effect, the incidence increases in the summer months, but the cause is unclear. The study concluded that the pathogenesis of acute appendicitis plays an important role in the infection, aerobic organisms predominate in the early stage of appendicitis, while mixed colonies are more common in the late stage of appendicitis. The most common organisms in gangrenous and perforated appendicitis are Escherichia coli. Children with rational fiber intake have a lower incidence of acute appendicitis than children who consume less fiber. Anatomical features are highly correlated with the clinical picture and can lead to diagnostic difficulties and there are features of clinical knowledge in each age group. The most common erroneous differential diagnoses and erroneous diagnoses are considered in the study. Diagnostic nuances are discussed. Surgical treatment and preoperative preparation are analysed and described. Taken together, nonsurgical treatment is a relatively safe treatment for children with good efficacy if the diagnosis is confirmed clinically, laboratory and mainly radiologically: acute uncomplicated appendicitis. Nonsurgical therapy includes: analgesia, adequate rehydration, and broad-spectrum antibacterial therapy (average 7 days). After starting nonsurgical treatment, a decision on further tactics should be made within 24 hours at the latest. Hospitalization times for surgically and conservatively treated patients do not differ significantly, and predominantly repeated hospitalizations are associated with patient concerns. A nonsurgical treatment is a good alternative to avoid a postoperative complications.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Akūts nekomplicēts apendicīts, neķirurģiska ārstēšana, bērnu ķirurģija., Acute uncomplicated appendicitis, nonsurgical treatment, pediatric surgery.