Pal K M, Khan A
Department of Surgery, Aga Khan University Hospital, Karachi.
J Pak Med Assoc. 1998 Jul;48(7):189-92.
Acute appendicitis is a common surgical emergency in urban setting, of a developing country. The computerised hospital patient database at Aga Khan University Hospital, Karachi, was utilised to obtain records of all adults with a histologically proven diagnosis of acute appendicitis. A review of patients treated over a 18 month period was undertaken. One hundred and three appendicectomies were performed for acute appendicitis during this period. The diagnosis was clinical in all cases. Investigations like leucocyte count and lower abdominal ultrasound scan were used to improve diagnostic accuracy without a clear advantage. A number of routine investigations like, haemoglobin estimation and urea, creatinine, electrolyte measurements, did not provide additional information. The duration of antibiotic treatment in acute simple appendicitis was empiric and could be reduced to a single preoperative dose. Peritoneal fluid culture studies had a poor yield (26%) and results were not found to effect management in acute simple appendicitis. The routine use of Ampicillin in all cases of bacterial peritonitis needs re-evaluation, as a high incidence (73%) of resistance was seen. Studies to define the role and duration of treatment, with a single antibiotic, in acute simple appendicitis should be undertaken. Acute appendicitis is probably the most frequently considered surgical differential diagnosis at any hospital dealing with acute surgical conditions. The established treatment continues to be surgical removal of the inflamed organ. The diagnosis and decision to operate both are accepted to be based on clinical judgement, though a number of investigative manoeuvres have been described to reduce the negative appendicectomy rate. Other areas of debate are the number and length of antibiotic treatment and use of bacterial culture studies in cases of simple acute appendicitis. To analyse present practice and identify areas for study and change, a retrospective study was undertaken at Aga Khan University Hospital (AKUH), Karachi.
在发展中国家的城市环境中，急性阑尾炎是一种常见的外科急症。利用卡拉奇阿迦汗大学医院的计算机化医院患者数据库，获取了所有经组织学证实诊断为急性阑尾炎的成年人的记录。对18个月期间接受治疗的患者进行了回顾。在此期间，因急性阑尾炎进行了103例阑尾切除术。所有病例均为临床诊断。白细胞计数和下腹部超声扫描等检查用于提高诊断准确性，但没有明显优势。血红蛋白测定、尿素、肌酐、电解质测量等一些常规检查并未提供额外信息。急性单纯性阑尾炎的抗生素治疗时间是经验性的，可以减至术前单次剂量。腹腔液培养研究的阳性率较低（26%），且结果未发现对急性单纯性阑尾炎的治疗有影响。在所有细菌性腹膜炎病例中常规使用氨苄西林需要重新评估，因为发现耐药率很高（73%）。应开展研究以确定单一抗生素在急性单纯性阑尾炎治疗中的作用和疗程。急性阑尾炎可能是任何处理急性外科疾病的医院最常考虑的外科鉴别诊断。既定的治疗方法仍然是手术切除发炎的器官。诊断和手术决定均被认为基于临床判断，尽管已经描述了一些检查手段以降低阴性阑尾切除率。其他有争议的领域包括单纯急性阑尾炎病例中抗生素治疗的次数和时长以及细菌培养研究的使用。为了分析当前的做法并确定研究和改进领域，在卡拉奇的阿迦汗大学医院（AKUH）进行了一项回顾性研究。
