Bergeron Eric
Department of Surgery, Charles-LeMoyne Hospital, Greenfield Park, QC.
Can J Surg. 2006 Apr;49(2):96-100.
Observation and repeated examination may lead to favourable clinical outcomes in the ever-challenging diagnosis of appendicitis. The goal of this study was to evaluate clinical performance in the diagnosis of suspected appendicitis in a centre with limited access to medical imaging technologies and to identify factors associated with complicated cases.
A retrospective review of the medical records of 211 consecutive surgical cases of suspected appendicitis, spanning an 11-year period, was performed. The delays before treatment and the subsequent patient outcomes were evaluated.
There were 8.1% of cases with negative findings on appendectomy, 75.8% with uncomplicated appendicitis, 12.3% with complicated appendicitis and 3.8% with other surgical conditions. The delay before the first medical consultation was significantly longer in patients with complicated appendicitis. The various delays after the first medical consultation did not differ significantly between the groups.
In the context of limited available medical imaging modalities, clinical observation was not associated with an increased incidence of complicated appendicitis. The presence of complicated appendicitis was associated with the delay before the patient's first medical consultation. Clinical judgment can be prioritized and can lead to good clinical performance in the management of patients with suspected appendicitis, with no significant increase in rates of complicated appendicitis and negative findings on appendectomy.
在阑尾炎这一颇具挑战性的诊断过程中，观察和反复检查可能会带来良好的临床结果。本研究的目的是评估在医疗影像技术获取受限的中心对疑似阑尾炎的诊断临床效能，并确定与复杂病例相关的因素。
对连续211例疑似阑尾炎手术病例的医疗记录进行了为期11年的回顾性研究。评估了治疗前的延迟时间以及随后的患者结局。
阑尾切除术中发现阴性结果的病例占8.1%，单纯性阑尾炎病例占75.8%，复杂性阑尾炎病例占12.3%，其他外科疾病病例占3.8%。复杂性阑尾炎患者首次就医前的延迟时间明显更长。首次就医后的各种延迟在各组之间无显著差异。
在可用医疗影像检查手段有限的情况下，临床观察与复杂性阑尾炎发病率的增加无关。复杂性阑尾炎的存在与患者首次就医前的延迟有关。在疑似阑尾炎患者的管理中，临床判断可作为优先考虑因素，且可带来良好的临床效果，复杂性阑尾炎的发生率和阑尾切除术中的阴性结果均无显著增加。
