Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
Hong Kong Med J. 2010 Feb;16(1):12-7.
To audit the appendectomies at our institute, and summarise atypical pathological results with a discussion of appropriate management. DESIGN. Retrospective study.
Regional hospital, Hong Kong.
All patients who underwent appendectomy for presumed acute appendicitis from June 2003 to June 2008 were recruited. Incidental appendectomy was excluded. Patient demographics, pathological findings, and surgical outcomes were analysed. RESULTS. The overall negative appendectomy rate was 18.2%. Female patients of reproductive age (11-50 years) conferred an independent risk for a higher negative appendectomy rate than other females (28.7% vs 11.5%; P<0.001). The overall perforation rate was 22.5%; the extremes of age (<11 or >70 years) conferred an independent risk of perforated appendicitis (25.2% vs 16.3%; P=0.002). Preoperative imaging was not associated with a lower negative appendectomy rate or rate for perforated appendicitis (P=0.205 and 0.218, respectively). Multivariate analysis suggested that a preoperative white cell count of less than 13.5 x 10(9) /L was an independent predictor of negative appendectomy (P<0.001); the body temperature and pulse rate of the patients with perforated appendicitis were higher than in those without perforation (P=0.004 and 0.003, respectively). Only 4.0% of the appendectomy specimens contained other appendiceal pathologies. Appendiceal diverticulitis was the most common inflammatory pathology, contributing to 2.7% of all appendectomies, followed by granulomatous appendicitis. In this series there were eight carcinoid tumours, three adenocarcinomas, two mucinous cystadenomas; tubular adenoma, metastatic deposition, mucinous cystadenocarcinoma and pseudomyxoma peritonei each occurred in one patient only.
A more focused utilisation of preoperative imaging in females of reproductive age and patients at the extremes of age is suggested. Long-term follow-up should be offered to patients with granulomatous appendicitis and neoplastic appendiceal diseases.
审核我院的阑尾切除术，并总结非典型病理结果，并讨论适当的处理方法。设计：回顾性研究。
香港地区医院。
所有于 2003 年 6 月至 2008 年 6 月期间因疑似急性阑尾炎而行阑尾切除术的患者均被纳入研究。意外阑尾切除术被排除在外。分析患者的人口统计学资料、病理发现和手术结果。
总的阴性阑尾切除率为 18.2%。育龄期女性（11-50 岁）比其他女性发生阴性阑尾切除的风险更高（28.7%比 11.5%；P<0.001）。总的穿孔率为 22.5%；年龄在极值（<11 岁或>70 岁）的患者发生穿孔性阑尾炎的风险独立升高（25.2%比 16.3%；P=0.002）。术前影像学检查与阴性阑尾切除率或穿孔性阑尾炎率无关（P=0.205 和 0.218）。多变量分析提示，术前白细胞计数<13.5 x 10(9) /L 是阴性阑尾切除的独立预测因素（P<0.001）；穿孔性阑尾炎患者的体温和脉搏率高于无穿孔性阑尾炎患者（P=0.004 和 0.003）。仅有 4.0%的阑尾切除标本包含其他阑尾病理。阑尾憩室炎是最常见的炎症性病变，占所有阑尾切除术的 2.7%，其次是肉芽肿性阑尾炎。在本系列中，有 8 个类癌瘤，3 个腺癌，2 个黏液性囊腺瘤；管状腺瘤、转移性沉积、黏液性囊腺癌和假性黏液瘤各仅 1 例。
建议在育龄期女性和极值年龄的患者中更有针对性地利用术前影像学检查。对肉芽肿性阑尾炎和肿瘤性阑尾疾病的患者应提供长期随访。
