Piper Hannah G, Rusnak Conrad, Orrom William, Hayashi Allen, Cunningham Johann
Department of Surgery, University of British Columbia and the Vancouver Island Health Authority, 1477 W 15th Ave., Suite 203, Vancouver, British Columbia, Canada V6H 1S4.
Am J Surg. 2008 May;195(5):585-8; discussion 588-9. doi: 10.1016/j.amjsurg.2007.12.033.
Controversies regarding the diagnosis and treatment of appendicitis remain. Practices and outcomes at a community center including imaging, timing of surgery, and surgical technique are reported.
From January to July 2006, 134 patients undergoing appendectomy in Victoria, British Columbia, were reviewed. Accuracy of preoperative imaging, time from the emergency room to the operating room, length of stay, and early complications were analyzed. Patients with and without perforation were compared using sample t tests.
Preoperative computed tomography was obtained for 101 patients (75%) with a negative appendectomy rate of 3% versus 10% for patients without imaging. Imaging did not prolong the time to surgery (11.8 vs 10.9 h, P = .48). Patients with perforation stayed in the hospital significantly longer and had more complications.
The liberal use of computed tomography resulted in fewer negative appendectomies without a significant delay to surgery. Patients with perforation had increased complications and longer hospitalizations. Efforts should be made to identify and treat early appendicitis.
阑尾炎的诊断和治疗仍存在争议。本文报告了一家社区中心在阑尾炎诊断和治疗方面的实践情况及结果，内容包括成像检查、手术时机和手术技术。
回顾性分析了2006年1月至7月间在不列颠哥伦比亚省维多利亚市接受阑尾切除术的134例患者。分析了术前成像检查的准确性、从急诊室到手术室的时间、住院时间和早期并发症情况。采用样本t检验对穿孔和未穿孔患者进行比较。
101例患者（75%）术前行计算机断层扫描，阴性阑尾切除率为3%；未进行成像检查的患者阴性阑尾切除率为10%。成像检查未延长手术时间（11.8小时对10.9小时，P = 0.48）。穿孔患者住院时间显著更长，并发症更多。
计算机断层扫描的广泛应用减少了阴性阑尾切除术的发生，且未显著延迟手术。穿孔患者并发症增多，住院时间延长。应努力识别并早期治疗阑尾炎。
