拉各斯的急性阑尾炎：250例病例回顾

Fashina I B, Adesanya A A, Atoyebi O A, Osinowo O O, Atimomo C J

Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria.

Niger Postgrad Med J. 2009 Dec;16(4):268-73.

OBJECTIVES

Acute appendicitis is common. This prospective study of 250 cases of acute appendicitis was performed to critically analyse the pattern of presentation, management, operative findings and treatment outcome. The effect of length and position of the appendix in relationship to acute inflammation was also determined.

PATIENTS AND METHODS

Two hundred and fifty cases of acute appendicitis were studied, including those found to have appendicitis at surgery despite other preoperative diagnosis. Patient biodata, clinical signs and symptoms were recorded. Haematological and biochemical parameters were determined after which all patients with a diagnosis of acute appendicitis had appendicectomy under general anaesthesia. All relevant peri-operative data were recorded. Excised appendices were sent for histological examination.

RESULTS

There were 133 males and 117 females giving a gender ratio of 1.2:1. The mean age was 25.7 +/- 10.3 years, with majority of cases (42.8%) occurring in the third decade of life. Abdominal pain (100%), fever (48.4%), anorexia (48.0%), vomiting (47.8%) were the common symptoms. Commonly elicited signs included right iliac fossa direct tenderness (74.4%), rebound tenderness (59.2%), localised guarding (42.8%) and right rectal wall tenderness (43.2%). The mean white cell count was not significantly elevated (mean 8538 +/- 4166 per mm3, P > 0.05). Sixty three percent (156/245) of all appendices were retrocaecal in position. Mean length of the appendices was 10.4 +/- 2.9 cm. The length and position of appendices were not significantly different between those who had acutely inflamed and normal appendices (P = 0.923) Two hundred and forty five patients (98%) with a diagnosis of acute appendicitis had appendicectomy. The commonest postoperative complication was wound infection (8%), overall complication rate was 13.5% and negative appendicectomy rate was 13.4%.

CONCLUSION

The presentation, management and treatment outcome of acute appendicitis in our centre are similar to those of other centres in our sub-region. Complication rates were low.

目的

急性阑尾炎很常见。本前瞻性研究纳入250例急性阑尾炎病例，旨在严格分析其临床表现模式、治疗方法、手术所见及治疗结果。同时还确定了阑尾长度和位置与急性炎症的关系。

患者与方法

对250例急性阑尾炎病例进行研究，包括那些尽管术前有其他诊断但在手术中发现患有阑尾炎的病例。记录患者的生物数据、临床体征和症状。测定血液学和生化参数，之后所有诊断为急性阑尾炎的患者均在全身麻醉下行阑尾切除术。记录所有相关的围手术期数据。将切除的阑尾送去做组织学检查。

结果

男性133例，女性117例，性别比为1.2:1。平均年龄为25.7±10.3岁，大多数病例（42.8%）发生在生命的第三个十年。腹痛（100%）、发热（48.4%）、厌食（48.0%）、呕吐（47.8%）是常见症状。常见的体征包括右下腹直接压痛（74.4%）、反跳痛（59.2%）、局限性肌紧张（42.8%）和直肠右壁压痛（43.2%）。白细胞计数平均值没有显著升高（平均每立方毫米8538±4166，P>0.05）。所有阑尾中有63%（156/245）位于盲肠后位。阑尾平均长度为10.4±2.9厘米。急性发炎阑尾与正常阑尾的长度和位置无显著差异（P = 0.923）。245例（98%）诊断为急性阑尾炎的患者接受了阑尾切除术。最常见的术后并发症是伤口感染（8%），总体并发症发生率为13.5%，阴性阑尾切除率为13.4%。