Leeuwenburgh Marjolein M N, Bakker Olaf J, Gorzeman Michiel P, Bollen Thomas L, Seldenrijk Cees A, Go Peter M N Y H
Sint Antonius ziekenhuis, Afd. Heelkunde, Nieuwegein, The Netherlands.
Ned Tijdschr Geneeskd. 2010;154:A869.
To evaluate the effect of the use of ultrasonography (US) and optional computed tomography (CT) or diagnostic laparoscopy on the percentage of unnecessary appendectomies in patients with suspected acute appendicitis.
Prospective and comparison with a historical control group.
Following the introduction of ultrasound imaging as an initial step, the outcomes in all patients presenting with suspected appendicitis in the emergency department were prospectively collected during a period of 18 months (July 2006-December 2007). Results were compared to retrospectively collected data on all patients who had undergone appendectomy for acute appendicitis in 2001, before the introduction of this imaging investigation.
Of the 312 consecutive patients in the emergency department with suspected acute appendicitis, the condition was excluded in 51 patients following clinical and laboratory investigation. The diagnostic algorithm was applied in 239 of the 261 patients (92%). All of them had initial US, followed by additional CT in 75 patients (31%) and diagnostic laparoscopy in 12 patients (5%). Appendectomy was performed in 130 patients, and 8 (6%) of the appendices were shown to be healthy following pathological investigation. Before the implementation of preoperative imaging 36 of the 170 appendices (21%) were healthy. Following the introduction of imaging techniques in accordance with the guideline there was a significant reduction in the percentage of unnecessary appendectomies (21% versus 6%; p < 0,001). The complete supplementary diagnostic algorithm had a positive and negative predictive value of respectively 90% and 98% for acute appendicitis.
Structural implementation of US with optional CT and diagnostic laparoscopy in patients with suspected acute appendicitis resulted in a lower percentage of unnecessary appendectomies.
评估超声检查（US）联合选择性计算机断层扫描（CT）或诊断性腹腔镜检查对疑似急性阑尾炎患者不必要阑尾切除术比例的影响。
前瞻性研究并与历史对照组比较。
以超声成像作为初始步骤，在18个月期间（2006年7月至2007年12月）前瞻性收集急诊科所有疑似阑尾炎患者的结局。将结果与2001年在引入该影像学检查之前因急性阑尾炎接受阑尾切除术的所有患者的回顾性收集数据进行比较。
在急诊科连续312例疑似急性阑尾炎患者中，51例经临床和实验室检查后排除该疾病。261例患者中的239例（92%）应用了诊断算法。他们均首先进行了超声检查，随后75例患者（31%）进行了额外的CT检查，12例患者（5%）进行了诊断性腹腔镜检查。130例患者接受了阑尾切除术，病理检查显示8例（6%）阑尾正常。在实施术前影像学检查之前，170例阑尾中有36例（21%）正常。按照指南引入影像学技术后，不必要阑尾切除术的比例显著降低（21%对6%；p<0.001）。完整的补充诊断算法对急性阑尾炎的阳性和阴性预测值分别为90%和98%。
对疑似急性阑尾炎患者结构性地实施超声检查联合选择性CT和诊断性腹腔镜检查可降低不必要阑尾切除术的比例。
