Wong Kenneth K Y, Cheung Tammy W Y, Tam Paul K H
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.
J Pediatr Surg. 2008 Dec;43(12):2239-41. doi: 10.1016/j.jpedsurg.2008.08.054.
Acute appendicitis is the most common emergency presenting to pediatric surgeons. With proper history and thorough physical examination, the diagnosis of the condition clinically should approach 90%. With the increasing ease of performing radiologic investigations because of technological advances, more ultrasound and computed tomography (CT) are used to help diagnosing appendicitis. The aim of this study is to review the trend of diagnosing appendicitis in a single center and discuss the implications.
A retrospective analysis was carried out for all patients who were admitted with acute appendicitis between 1997 and 2007. The methods of diagnosis were divided into 3 groups as follows: clinical, ultrasound, and CT. The demographics and operative findings were noted. Statistical analysis was done using Fisher's Exact test and paired t test when appropriate. A value of P < .05 was considered to be statistically significant.
During this period, a total of 254 patients (167 boys and 87 girls) were admitted with appendicitis. The average age at presentation was 12 years, and the mean duration of symptoms before presentation was 2 days. For 11 years, there was an initial rise of the use of ultrasound (10% in 1997 to a peak of 60% in 2005). This percentage decreased with a corresponding rise of the use of CT scan (0% in 1997 to 35% in 2007). There was no correlation found between the use of adjunct investigations and the severity of appendicitis found at operation, suggesting an overreliance of CT.
It appears that there is an increasing trend in using radiologic investigations for the diagnosis of appendicitis for the past 11 years. With the association of cancer in later life and early radiation exposure well documented, it would be advisable to avoid the use of CT if possible.
急性阑尾炎是小儿外科医生面对的最常见急症。凭借恰当的病史和全面的体格检查，该病症的临床诊断准确率应接近90%。由于技术进步，进行放射学检查越来越容易，更多的超声和计算机断层扫描（CT）被用于辅助诊断阑尾炎。本研究旨在回顾单中心阑尾炎诊断的趋势并探讨其影响。
对1997年至2007年间因急性阑尾炎入院的所有患者进行回顾性分析。诊断方法分为以下3组：临床诊断、超声诊断和CT诊断。记录人口统计学数据和手术所见。在适当情况下使用Fisher精确检验和配对t检验进行统计分析。P值<0.05被认为具有统计学意义。
在此期间，共有254例患者（167例男孩和87例女孩）因阑尾炎入院。就诊时的平均年龄为12岁，就诊前症状的平均持续时间为2天。在11年中，超声检查的使用最初有所上升（从1997年的10%升至2005年的峰值60%）。该百分比随着CT扫描使用的相应增加而下降（从1997年的0%升至2007年的35%）。辅助检查的使用与手术中发现的阑尾炎严重程度之间未发现相关性，这表明对CT存在过度依赖。
在过去11年中，使用放射学检查诊断阑尾炎似乎有增加的趋势。鉴于晚年患癌与早期辐射暴露之间的关联已有充分记录，如有可能应避免使用CT。
