Arfa Nafaa, Gharbi Lassaad, Marsaoui Lobna, Ben Rhouma Sami, Farhati Sameh, Bougamra Sirine, Mannai Saber, Ghariani Brahim, Mestiri Hafedh, Khalfallah Mohamed Tahar
Service de Chirurgie Générale, Hôpital Mongi Slim, La Marsa, Tunisie.
Presse Med. 2006 Mar;35(3 Pt 1):393-8. doi: 10.1016/s0755-4982(06)74602-4.
Because of the potential severity of acute appendicitis, many authors recommend the broad use of appendectomy. In this case, 15 to 20% of appendectomies are ultimately found to have been unnecessary. Hospital observation with repeated clinical and laboratory exams can be useful for patients with atypical clinical presentation. This paper assesses our approach, in which some patients with pain in the right iliac fossa (RIF) are admitted for observation before a decision about appendectomy.
All patients (205 cases) admitted from March 2002 through February 2003 for acute abdominal pain of the RIF were included in this prospective study. The 120 women and 85 men (sex ratio=0.7) had a mean age of 27 years. We classified the patients into 3 groups: those who had an emergency appendectomy, those who had surgery after an observation period, and those discharged without appendectomy after observation.
The first group included 110 patients: 63% had a (rectal) temperature greater than 38 degrees C; 44% had guarding of the RIF and 87% elevated white blood cell counts (>10000/mm3). At surgery, appendicitis was diagnosed in 92%. After a mean delay of 36 hours of observation, 50 of the patients in the second group underwent surgery: 44% with (rectal) temperature > 38 degrees C, RIF guarding in 8%, and elevated white blood cell count (>10000/mm3) in 74%. In this group, 94% were diagnosed with appendicitis during surgery. Forty-five patients were discharged without surgery after 36 hours of observation.
In this study, pain and RIF guarding, associated with temperature greater than 38 degrees C and elevated white blood cell counts, were predictive of appendicitis in 96% of cases. Admission for observation of patients with atypical presentation avoided 45 unnecessary appendectomies (22%).
鉴于急性阑尾炎可能的严重性，许多作者建议广泛采用阑尾切除术。在此情况下，最终发现15%至20%的阑尾切除术是不必要的。对于临床表现不典型的患者，通过反复进行临床和实验室检查进行住院观察可能会有所帮助。本文评估了我们的方法，即对于一些右下腹（RIF）疼痛的患者，在决定是否进行阑尾切除术之前先收入院观察。
本前瞻性研究纳入了2002年3月至2003年2月因RIF急性腹痛入院的所有患者（205例）。其中120名女性和85名男性（性别比=0.7），平均年龄为27岁。我们将患者分为3组：进行急诊阑尾切除术的患者、观察期后进行手术的患者以及观察后未进行阑尾切除术而出院的患者。
第一组包括110名患者：63%的患者（直肠）体温高于38摄氏度；44%的患者右下腹有压痛，87%的患者白细胞计数升高（>10000/mm³）。手术时，92%的患者被诊断为阑尾炎。在平均观察36小时后，第二组中的50名患者接受了手术：44%的患者（直肠）体温>38摄氏度，8%的患者右下腹有压痛，74%的患者白细胞计数升高（>10000/mm³）。在这组患者中，94%在手术时被诊断为阑尾炎。45名患者在观察36小时后未进行手术而出院。
在本研究中，疼痛、右下腹压痛，伴有体温高于38摄氏度和白细胞计数升高，在96%的病例中可预测阑尾炎。对临床表现不典型的患者进行入院观察避免了45例不必要的阑尾切除术（22%）。
