儿童急性阑尾炎的临床特征与诊疗新进展

Clinical Features and Recent Advances in the Diagnosis and Management of Pediatric Acute Appendicitis

摘要: 急性阑尾炎是儿童最常见的急腹症之一，其临床表现具有显著的年龄异质性，低龄患儿症状不典型，诊断难度大，且病情进展快，易发展为复杂性阑尾炎。近年来，其诊疗模式从单一的手术治疗，逐步向基于精准评估的个体化、微创化治疗转变。诊断层面，血清学标志物从传统的白细胞计数、C反应蛋白，发展到联合应用中性粒细胞/淋巴细胞比值、降钙素原、白介素-6、纤维蛋白原等新型指标，诊断效能与预测能力显著提升。影像学检查中，超声仍为首选，计算机断层扫描在疑难病例中发挥关键作用。人工智能辅助诊断与预测模型为早期识别高风险患儿提供了新工具。治疗层面，对于复杂性阑尾炎，初始非手术治疗(抗生素 ± 穿刺引流)已成为重要选择；内镜逆行阑尾炎治疗术为单纯性阑尾炎提供了保留器官功能的微创方案；而经脐单孔腹腔镜阑尾切除术则进一步推动了手术的微创与美观。本文系统阐述了儿童急性阑尾炎的流行病学、病因、临床特点，并对当前诊断与治疗领域的最新进展进行综述，旨在为临床实践提供参考。

Abstract: Acute appendicitis is one of the most common causes of acute abdominal pain in children. Its clinical presentation varies considerably with age, and younger children often present with atypical symptoms, making early diagnosis challenging. Due to rapid disease progression and a high risk of perforation, timely identification and appropriate management are essential. In recent years, the diagnostic and therapeutic strategies for pediatric acute appendicitis have gradually shifted from conventional surgery-centered approaches toward individualized and minimally invasive management based on precise clinical assessment. Regarding diagnosis, inflammatory biomarkers have evolved from traditional indicators such as white blood cell count and C-reactive protein to combined models incorporating novel markers including the neutrophil-to-lymphocyte ratio, procalcitonin, interleukin-6, and fibrinogen, thereby improving diagnostic accuracy and risk stratification. Ultrasound remains the preferred first-line imaging modality, whereas computed tomography plays an important complementary role in complicated or equivocal cases. In addition, artificial intelligence-assisted predictive models have shown promising value in the early identification of high-risk patients. With respect to treatment, non-operative management with antibiotics, with or without image-guided drainage, has become an important option for selected cases of complicated appendicitis (including gangrenous and perforated appendicitis). Endoscopic retrograde appendicitis therapy provides a novel minimally invasive and organ-preserving approach for uncomplicated appendicitis, while transumbilical single-port laparoscopic appendectomy further improves cosmetic outcomes and postoperative recovery. This review summarizes the epidemiology, etiology, clinical manifestations, diagnostic strategies, and therapeutic advances in pediatric acute appendicitis, with the aim of providing references for clinical practice and future research.