什么是阳性阑尾炎？一个老问题的新答案。200 例连续阑尾切除术的临床、大体和显微镜检查结果。

What is positive appendicitis? A new answer to an old question. Clinical, macroscopical and microscopical findings in 200 consecutive appendectomies.

机构信息

Minimal Access Unit, Department of General Surgery, Princess Royal University Hospital, Farnborough Common, Orpington, BR6 8ND, Greater London, UK.

出版信息

Singapore Med J. 2009 Dec;50(12):1145-9.

PMID:20087549

Abstract

INTRODUCTION

The correlation between clinical and histopathology findings in appendicitis has been highlighted by many studies. However, the impact of this correlation on the surgical decision to remove a normal-looking appendix is still vague, with no clear definition of positive appendicitis. The aim of this study was to correlate the histological, operative and clinical diagnoses of acute appendicitis (AA).

METHODS

200 patients with a preoperative diagnosis of AA underwent laparoscopic appendectomy. A single consultant surgeon performed all the procedures. The clinical, macroscopical and microscopical outcomes were reported and analysed. Follow-up assessment was performed as an outpatient appointment.

RESULTS

112 women and 88 men were included in this study. The mean age was 18.8 (range 8-83) years. Macroscopical appendicitis was confirmed in 139 (69.5 percent) patients, while microscopical appendicitis was reported in 147 (73.5 percent) specimens of the appendix. Ten (7.2 percent) out of 139 patients who were macroscopically positive were found to have a normal appendix on microscopical examination. Different pathologies were found in 21 (10.5 percent) patients, and all underwent appendectomy. Microscopical appendicitis was confirmed in 10 (25 percent) out of 40 patients who had a normal-looking appendix.

CONCLUSION

The correlation of the clinical, microscopical and macroscopical findings in AA is important in order to understand the natural history of appendicitis, and this may help to formulate a sound surgical decision. These findings are supportive of justifying appendectomy for normal-looking appendices, if no other pathology is found.

摘要

简介

许多研究都强调了阑尾炎的临床和组织病理学表现之间的相关性。然而，这种相关性对切除外观正常的阑尾的手术决策的影响仍然模糊不清，对于阳性阑尾炎尚无明确的定义。本研究旨在对急性阑尾炎（AA）的组织学、手术和临床诊断进行相关性分析。

方法

200 例术前诊断为 AA 的患者接受了腹腔镜阑尾切除术。由一位主治外科医生完成所有手术。报告和分析了临床、宏观和微观结果。通过门诊预约进行随访评估。

结果

本研究纳入了 112 名女性和 88 名男性患者，平均年龄为 18.8 岁（范围为 8-83 岁）。139 例（69.5%）患者的阑尾外观异常，147 例（73.5%）阑尾标本有显微镜下的阑尾炎表现。在 139 例宏观上为阳性的患者中，有 10 例（7.2%）在微观检查中发现阑尾正常。21 例（10.5%）患者有不同的病理改变，所有患者均接受了阑尾切除术。在 40 例外观正常的患者中，有 10 例（25%）经显微镜检查证实为阑尾炎。