Hawthorn I E
Department of Surgery, Princess of Wales' Royal Air Force Hospital, Ely, UK.
J R Coll Surg Edinb. 1992 Dec;37(6):389-93.
Between 1 January 1988 and 31 December 1989, 525 patients were admitted to one hospital with a diagnosis of acute abdominal pain. Of these, 182 (34.7%) underwent an emergency operation and 14 (7.7%) of these patients subsequently died within 30 days. Death was due to intestinal obstruction in 69%, and there was a 28% mortality rate for emergency colonic resection. Non-specific abdominal pain (NSAP) was the most common diagnosis (36.0%), followed by appendicitis (14.9%) and urological causes (12.8%). There was an unnecessary appendicectomy rate of 25.0%. Admission with pain because of urological causes was over twice that of previous reports. Duration of stay increased greatly with age. Results from this study confirm the high mortality rate in the elderly from emergency colonic resection. Greater care in diagnosis and a conservative approach to appendicitis, with laparoscopy in females of reproductive age, may produce a lower unnecessary appendicectomy rate without an increase in morbidity. If the diagnosis of NSAP could be made earlier and patients discharged sooner, a large saving in resources would result. This early diagnosis is not yet possible.
1988年1月1日至1989年12月31日期间，一家医院收治了525例诊断为急性腹痛的患者。其中，182例（34.7%）接受了急诊手术，这些患者中有14例（7.7%）在随后的30天内死亡。69%的死亡原因是肠梗阻，急诊结肠切除术的死亡率为28%。非特异性腹痛（NSAP）是最常见的诊断（36.0%），其次是阑尾炎（14.9%）和泌尿系统病因（12.8%）。不必要的阑尾切除术发生率为25.0%。因泌尿系统病因入院疼痛的发生率是此前报告的两倍多。住院时间随年龄大幅增加。本研究结果证实了老年患者急诊结肠切除术的高死亡率。在诊断上更加谨慎，对阑尾炎采取保守治疗方法，对育龄女性采用腹腔镜检查，可能会降低不必要的阑尾切除术发生率，且不会增加发病率。如果能更早诊断出NSAP并让患者更快出院，将节省大量资源。但目前尚无法做到早期诊断。
