Gürleyik Günay, Gürleyik Emin
Department of Surgery, Haydarpasa Numune Teaching and Research Hospital, Istanbul, Turkey.
Eur J Emerg Med. 2003 Sep;10(3):200-3. doi: 10.1097/01.mej.0000088431.19737.f8.
Acute appendicitis, the most common cause of abdominal surgical emergency, shows a different pathogenesis, clinical course and outcome in the elderly. Age-specific factors are effective on preoperative clinical diagnosis and on the stage of this infectious disease. We aimed to present our experience with a series of elderly patients with appendicitis who were subjected to appendectomy. Operative and hospital records of patients with appendicitis were retrospectively reviewed. Patients who were 50 years of age or older were the main constituents of the study. Demographic features, preoperative clinical diagnosis, abdominal interventions, and postoperative morbidity and mortality were analysed as the main criteria. A total of 109 older patients have constituted 4.3% of our appendectomy cases. Besides right lower quadrant transversal incisions, surgery was performed via vertical incisions in 28.4% of cases with a diagnosis of acute abdomen. In the elderly, the perforation rate was significantly higher than in paediatric and adult patients (P<0.001). The proportion of the elderly among perforated cases was significantly increased when compared with non-perforated cases (12.9 versus 2.9%; P<0.001). Postoperative morbidity was noted in 35.8% of elderly patients, in 73.8% of perforated, and in 11.9% of non-perforated cases (P<0.001). The mortality rate was 5.5% in the elderly group, 11.9% in patients with perforated, and 1.5% in patients with non-perforated appendicitis. No mortality was noted in patients younger than 50 years. The precise diagnosis of appendicitis is relatively low in the elderly. Despite the uncommon occurrence of appendicitis, the perforation rate is still unfavourable. Postoperative morbidity and mortality is unacceptably high. Advancing age adversely affects clinical diagnosis, the stage of disease and the outcome of patients. Perforated appendicitis and septic progression is the main cause of undesirable outcomes.
急性阑尾炎是腹部外科急症最常见的病因，在老年人中其发病机制、临床病程及预后有所不同。特定年龄因素对术前临床诊断及这种传染病的分期有影响。我们旨在介绍一系列接受阑尾切除术的老年阑尾炎患者的治疗经验。对阑尾炎患者的手术及住院记录进行回顾性分析。年龄在50岁及以上的患者是本研究的主要对象。将人口统计学特征、术前临床诊断、腹部干预措施以及术后发病率和死亡率作为主要分析标准。共有109例老年患者，占我们阑尾切除病例的4.3%。除右下腹横切口外，28.4%诊断为急腹症的病例采用纵切口进行手术。在老年人中，穿孔率显著高于儿童和成年患者（P<0.001）。与未穿孔病例相比，穿孔病例中老年人的比例显著增加（12.9%对2.9%；P<0.001）。35.8%的老年患者出现术后并发症，穿孔患者中为73.8%，未穿孔患者中为11.9%（P<0.001）。老年组死亡率为5.5%，穿孔患者为11.9%，未穿孔阑尾炎患者为1.5%。50岁以下患者未出现死亡病例。老年人阑尾炎的准确诊断率相对较低。尽管阑尾炎发病率不高，但穿孔率仍然不容乐观。术后发病率和死亡率高得令人难以接受。年龄增长对临床诊断、疾病分期及患者预后产生不利影响。穿孔性阑尾炎和感染进展是不良预后的主要原因。
