IMPACT OF THE APPENDICEAL POSITION ON THE DIAGNOSIS AND TREATMENT OF PEDIATRIC APPENDICITIS

ABSTRACT Objective: To investigate how symptoms vary according to the appendiceal position in pediatric patients and to demonstrate that the laparoscopic approach is safe and effective in any appendiceal location by comparing each location to another. Methods: The medical records of 1,736 children aged 14 or younger who underwent laparoscopic appendectomy over a period of 14 years were analyzed retrospectively. Patients were divided according to the position of the appendiceal tip into four groups: anterior, pelvic, retrocecal and subhepatic. The Kruskal-Wallis and chi-square tests were used with the Bonferroni correction, with a significant p<0.05. Results: The appendiceal location was anterior in 1,366 cases, retrocecal in 248 cases, pelvic in 66 cases and subhepatic in 56 cases. There were no significant differences between the groups in terms of patient age and gender. Abdominal pain was the only symptom with statistically significant differences between the groups. The rate of perforated appendicitis was higher in the subhepatic and pelvic positions. Intraoperative complications and conversions were not statistically significant. Technical difficulties and operative time were higher in subhepatic position. The rate of postoperative complications was similar between the different locations, except for bowel obstruction, which was higher in pelvic appendicitis. Conclusions: The clinical symptoms of appendicitis hardly ever change with the position of the appendix. The laparoscopic approach is safe and effective, regardless the appendiceal location.

摘要
研究目的：探讨儿童患者阑尾炎症状随阑尾位置的变化规律，并通过对比不同阑尾位置，证明腹腔镜阑尾切除术在任意阑尾位置下均具备安全性与有效性。
方法：回顾性分析14年间1736名14岁及以下接受腹腔镜阑尾切除术的儿童的病历资料。根据阑尾尖端位置将患者分为四组：前位组、盆腔位组、盲肠后位组及肝下位组。采用克拉斯卡尔-沃利斯（Kruskal-Wallis）检验与卡方检验，并进行邦费罗尼（Bonferroni）校正，以p<0.05作为差异具有统计学意义的判定标准。
结果：阑尾位置分布为前位1366例、盲肠后位248例、盆腔位66例、肝下位56例。各组患者的年龄与性别均无显著组间差异。腹痛为各组间存在统计学差异的唯一临床症状。肝下位与盆腔位阑尾炎的穿孔率更高。术中并发症发生率与中转手术率的组间差异无统计学意义。肝下位阑尾切除术的操作难度更高，手术时长更长。除盆腔位阑尾炎的肠梗阻发生率更高外，其余不同位置组的术后并发症发生率无显著差异。
结论：阑尾炎的临床症状几乎不会随阑尾位置改变而发生变化。无论阑尾位置如何，腹腔镜手术均安全有效。