Partrick David A, Janik James E, Janik Joseph S, Bensard Denis D, Karrer Frederick M
Department of Pediatric Surgery, The Children's Hospital, University of Colorado, Denver, CO, USA.
J Pediatr Surg. 2003 May;38(5):659-62. doi: 10.1016/jpsu.2003.5017.
BACKGROUND/PURPOSE: Appendicitis continues to present a diagnostic dilemma in children of all ages leading to increased utilization of radiographic studies. Focused computed tomography (CT) scanning has become the diagnostic test of choice in many hospitals. The purpose of this study was to critically evaluate the use of radiographic studies for the evaluation of acute appendicitis in children and to determine if diagnostic accuracy has improved.
Children undergoing appendectomy for acute appendicitis were reviewed from 1997 to 2001. Diagnostic workup (CT scan, ultrasound [US], or no radiographic study) was recorded as were the final pathology results.
Six hundred sixteen appendectomies were performed. Mean age was 10.4 +/- 4.1 years, and 60% were boys. Overall, 184 children (30%) underwent CT scanning, 104 (17%) had US performed, and 310 (50%) had no radiographic study (18 patients had both CT and US performed). A pathologically normal appendix was removed in 7% (14 of 202) of CT patients, 11% (14 of 122) of US patients, and 8% (26 of 310) of patients without a study. The frequency of CT scanning increased from 1.3% of all children in 1997 to 58% in 2001, whereas utilization of US decreased from 40% to 7%. Over the same period, the overall negative appendectomy rate did not change significantly from 8% to 7%.
With increased utilization of focused CT scanning, the negative appendectomy rate has remained unchanged. History and physical examination by an experienced surgeon is as accurate as CT in correctly diagnosing acute appendicitis in children.
背景/目的：阑尾炎在各年龄段儿童中一直存在诊断难题，导致影像学检查的使用增加。针对性计算机断层扫描（CT）已成为许多医院首选的诊断检查方法。本研究的目的是严格评估影像学检查在儿童急性阑尾炎评估中的应用，并确定诊断准确性是否有所提高。
回顾1997年至2001年因急性阑尾炎接受阑尾切除术的儿童。记录诊断检查（CT扫描、超声[US]或未进行影像学检查）及最终病理结果。
共进行了616例阑尾切除术。平均年龄为10.4±4.1岁，60%为男孩。总体而言，184名儿童（30%）接受了CT扫描，104名（17%）接受了超声检查，310名（50%）未进行影像学检查（18名患者同时接受了CT和超声检查）。CT检查患者中7%（202例中的14例）阑尾病理正常，超声检查患者中11%（122例中的14例）阑尾病理正常，未进行检查的患者中8%（310例中的26例）阑尾病理正常。CT扫描的使用频率从1997年所有儿童的1.3%增至2001年的58%，而超声检查的使用率从40%降至7%。同期，总体阴性阑尾切除率从8%降至7%，无显著变化。
随着针对性CT扫描使用的增加，阴性阑尾切除率保持不变。经验丰富的外科医生进行的病史采集和体格检查在正确诊断儿童急性阑尾炎方面与CT一样准确。
