Rennie Adam T M, Tytherleigh Matthew G, Theodoroupolou Katerina, Farouk Ridzuan
Department of Surgery, Royal Berkshire Hospital, Reading, UK.
Ann R Coll Surg Engl. 2006 Mar;88(2):140-3. doi: 10.1308/003588406X94887.
A prospective study of 300 women of child-bearing age presenting with right iliac fossa pain was carried out to determine what proportion had appendicitis and whether active observation resulted in a delay in diagnosis to the detriment of the patient.
Data were prospectively collected for 300 consecutive women of childbearing age referred with right iliac fossa pain to general surgeons at a district general hospital.
After clinical assessment, 71 were discharged home immediately. Two others were found to be pregnant and 4 admitted to gynaecology. The remaining 223 women were admitted to the general surgical unit, 112 of whom underwent immediate appendicectomy. Of these, 97 had acute appendicitis. Two suffered deep infection and two had a superficial wound infection. A further decision to operate was made in 42 of 111 patients admitted for active observation, with 36 having acute appendicitis and 2 having a carcinoid tumour. Four had a wound infection. The average in-patient stay of those admitted for active observation and not operated on was 2 days (range, 1-4 days) compared with a length of stay of 2 days (range, 1-7 days) for those who underwent 'immediate' appendicectomy.
Most women of child-bearing age who present with right iliac fossa pain do not have appendicitis. Those who do not have the classical features of appendicitis or peritonism can be safely managed by active observation.
对300名出现右下腹疼痛的育龄女性进行了一项前瞻性研究，以确定患阑尾炎的比例，以及积极观察是否会导致诊断延迟并对患者造成不利影响。
前瞻性收集了连续300名因右下腹疼痛转诊至一家地区综合医院普通外科医生处的育龄女性的数据。
经过临床评估，71人立即出院回家。另外两人被发现怀孕，4人入住妇科。其余223名女性入住普通外科病房，其中112人立即接受了阑尾切除术。在这些人中，97人患有急性阑尾炎。两人发生深部感染，两人出现浅表伤口感染。在111名接受积极观察的患者中，有42人进一步决定进行手术，其中36人患有急性阑尾炎，2人患有类癌肿瘤。4人出现伤口感染。接受积极观察但未手术的患者平均住院时间为2天（范围为1 - 4天），而接受“立即”阑尾切除术的患者住院时间为2天（范围为1 - 7天）。
大多数出现右下腹疼痛的育龄女性没有患阑尾炎。那些没有阑尾炎或腹膜炎典型特征的患者可以通过积极观察安全地进行处理。
