Chandrasegaram Manju D, Rothwell Lincoln A, An Ethan I, Miller Rose J
Royal Adelaide Hospital, Adelaide, South Australia, Australia.
ANZ J Surg. 2012 Nov;82(11):844-7. doi: 10.1111/j.1445-2197.2012.06185.x. Epub 2012 Aug 24.
Debate surrounds the management of the macroscopically normal appendix. Current literature recommends its removal given the high incidence of microscopic appendicitis, and other unusual pathologies in the normal-looking appendix. Negative appendicectomies are reported on the decline with increased use of diagnostic radiological adjuncts.
This study analysed pathologies of the appendix over 10 years in the Pathology Department in Canberra. A positive appendicectomy was defined as acute appendicitis, faecoliths, worms, endometriosis or appendiceal tumours. We reviewed the positive appendicectomy rate over this time period.
There were 4670 appendicectomy specimens in 2386 males (51.1%) and 2284 (49%) females. The incidence of acute appendicitis was 71.3% and the positive appendicectomy rate was 76.3%. There were significantly fewer negative appendicectomies in males (16.8%) compared with females (31.0%). There was no appreciable change in this trend over the study period. Of the positive appendicectomies, there were 129 (3.6%) faecoliths. Of these, only 39.5% had concomitant appendicitis. There were 44 (1.2%) specimens identified with worms. Of these, 40.9% had concomitant appendicitis. There were 14 cases of endometriosis of the appendix of which 36% had concomitant appendicitis. There were 58/3562 (1.6%) appendiceal tumours within the positive appendicectomy group the majority of which were carcinoid tumours (65.5%).
There is a higher incidence of negative appendicectomies in women compared with men, which is similar to other published studies. Faecoliths and worms are a known cause of appendiceal colic and in our series were identified mostly in the absence of histological evidence of appendicitis.
对于肉眼外观正常的阑尾的处理方式存在争议。鉴于显微镜下阑尾炎以及外观正常的阑尾中其他不常见病变的高发生率，当前文献建议切除阑尾。据报道，随着诊断性放射学辅助手段使用的增加，阴性阑尾切除术的发生率在下降。
本研究分析了堪培拉病理科10年间阑尾的病理情况。阳性阑尾切除术定义为急性阑尾炎、粪石、蠕虫、子宫内膜异位症或阑尾肿瘤。我们回顾了这一时间段内的阳性阑尾切除术发生率。
共有4670例阑尾切除标本，其中男性2386例（51.1%），女性2284例（49%）。急性阑尾炎的发生率为71.3%，阳性阑尾切除术发生率为76.3%。男性的阴性阑尾切除术发生率（16.8%）显著低于女性（31.0%）。在研究期间，这一趋势没有明显变化。在阳性阑尾切除术中，有129例（3.6%）发现粪石。其中，只有39.5%伴有阑尾炎。有44例（1.2%）标本发现蠕虫。其中，40.9%伴有阑尾炎。有14例阑尾子宫内膜异位症，其中36%伴有阑尾炎。在阳性阑尾切除组中有58/3562（1.6%）例阑尾肿瘤，其中大多数为类癌肿瘤（65.5%）。
与男性相比，女性阴性阑尾切除术的发生率更高，这与其他已发表的研究结果相似。粪石和蠕虫是已知的阑尾绞痛病因，在我们的系列研究中，大多在没有阑尾炎组织学证据的情况下被发现。
