Clinical value of high frequency ultrasound and contrast-enhanced ultrasound-guided endoscopic in the treatment of suppurative appendicitis caused by fecalith in children
Objective To explore the clinical value of high frequency ultrasound and intraoperative contrast-enhanced ultrasound-guided endoscopic retrograde appendicitis therapy(ERAT)combined with digital cholangioscopy in the treatment of pediatric suppurative appendicitis caused by fecalith in children.Methods Retrospective analysis of endoscopic treatment history of 48 children with suppurative appendicitis caused by fecalith was performed.Preoperatively,high-frequency ultrasound was performed to measure the outer diameter of the appendix,the thickness of the appendix wall and the diameter of the fecalith,and observe whether the surrounding omentum was thickened.Intraoperatively,intraoperative contrast-enhanced ultrasound was used to observe and record whether the fecalith was removed successfully and whether the appendix was perforated.According to the treatment results,39 cases in successful fecaliths removal group and 9 cases in intraoperative perforation group were divided.The coincidence rate between ultrasound and digital cholangioscopy was analyzed,and the occurence of complications was recorded.After treatment,the children were regularly followed up.Ultrasound parameters,clinical symptoms,and laboratory indicators were compared between the two groups.Results In 48 children,intraoperative contrast-enhanced ultrasound showed that fecaliths were successfully removed in 39 cases,and appendiceal perforation occurred in 9 cases.Digital cholangioscopy showed that fecaliths were successfully removed in 34 cases,and appendix rupture in 5 cases.The concordance rates between the two modalities were 87.17%and 55.56%,respectively.No significant complications were observed in the successful fecaliths removal group,1 case of periappendiceal encapsulated abscess occurred in the intraoperative perforation group.There were significant differences between the two groups in appendix wall thickness and omentum thickness returned to normal reference time,disappearance time of abdominal pain and fever,and normal time of white blood cell count and C reactive protein were all statistically significant(all P<0.05).In successful fecaliths removal group,35,4 and 0 cases were excellent,good and poor,respectively.In the intraoperative perforation group,0,8 and 1 cases were excellent,good and poor,respectively.There was no significant difference in the excellent treatment rate(100%vs.88.89%)between the two groups.Conclusion High-frequency ultrasound and intraoperative contrast-enhanced ultrasound-guided ERAT combined with digital cholangioscopy for the treatment of pediatric suppurative appendicitis caused by fecalith demonstrates real-time,high precision,high cure rate and minimal complications,and has certain clinical value.
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