Pokharel N, Sapkota P, Kc B, Rimal S, Thapa S, Shakya R
Department of surgery, Lumbini Medical College, Pravas, Tansen, Nepal.
Nepal Med Coll J. 2011 Dec;13(4):285-8.
The classic symptoms of acute appendicitis are seldom seen in the elderly patient. More subtle symptoms and the more virulent pathologic course allow the disease to progress rapidly and insidiously. This leads to delayed hospitalization, diagnosis and treatment. The high incidence of concomitant diseases and the multiplicity of differential diagnostic possibilities in this age group are also factors. The aim of this study is to compare the results of appendicitis operated at Lumbini Medical College, Pravas, in patients younger than 60 and patient elder than 60 years of age. All patients aged 60 years and older who underwent appendectomy for appendicitis between January 2008, and December 2011, were studied and compared with the patients who were younger than 60 years of age. All the operations were performed by consultant surgeons at Lumbini Medical College, Pravas, Tansen. Preoperative USG was done in all the cases. Preoperative antibiotics were given in all the cases. All patients underwent appendectomy as an emergency basis. The results were compared with regard to age, sex, pre-operative evaluation, operative duration and findings, postoperative course, duration of hospital stay, and mortality rate. There were 50 patients in group 1 and 150 patients in group 2 who met the inclusion criteria. The mean age (64 years for group 1 and 28 years for group 2), sex, preoperative suggestion of appendicitis (group 1, 35 [70%] of 50 patients; group 2, 135 [90%] of 150 patients), and duration of the preoperative hospitalization over 24 hours (group 1, 1 patients [20%]; group 2, 30 patients [20%]) were similar in both groups. Laparoscopy was used in (group 1, 5 patients [10%]; group 2, 6 patients [4%] and associated with no significant difference in the duration of hospitalization, frequency of appendiceal perforation or abscess, occurrence of complications, or mortality. The length of operating time was more in the first group. The mean hospital stay was 5.3 in group 1 and 2.2 in group 2 (p < 0.05). Also duration of Hospital stay was 9.5 days for perforated appendicitis and 5.4 for non perforated appendicitis in both group (p < 0.05). Advanced age adversely affects clinical diagnosis, the stage of the disease and the outcomes. Late presentation, delayed diagnosis, presence of perforation and co-morbidities are associated with poor outcome from surgery.
老年患者很少出现急性阑尾炎的典型症状。更为隐匿的症状以及更凶险的病理过程使得疾病迅速且隐匿地发展。这导致住院、诊断和治疗延迟。该年龄组伴随疾病的高发病率以及多种鉴别诊断可能性也是相关因素。本研究的目的是比较在蓝毗尼医学院（位于普拉瓦斯）接受阑尾炎手术的60岁以下患者和60岁以上患者的结果。对2008年1月至2011年12月期间因阑尾炎接受阑尾切除术的所有60岁及以上患者进行了研究，并与60岁以下患者进行比较。所有手术均由蓝毗尼医学院（位于普拉瓦斯、坦森）的顾问外科医生进行。所有病例均进行了术前超声检查。所有病例均给予了术前抗生素。所有患者均作为急诊接受阑尾切除术。比较了两组患者在年龄、性别、术前评估、手术时长及发现、术后病程、住院时间和死亡率等方面的结果。第1组有50例患者，第2组有150例患者符合纳入标准。两组患者的平均年龄（第1组64岁，第2组28岁）、性别、术前阑尾炎提示（第1组，50例患者中的35例[70%]；第2组，150例患者中的135例[90%]）以及术前住院超过24小时的时长（第1组，1例患者[20%]；第2组，30例患者[20%]）相似。第1组有5例患者（10%）、第2组有6例患者（4%）采用了腹腔镜手术，在住院时长、阑尾穿孔或脓肿发生率、并发症发生情况或死亡率方面无显著差异。第1组的手术时间更长。第1组的平均住院时间为5.3天，第2组为2.2天（p<0.05）。两组中穿孔性阑尾炎的住院时间为9.5天，非穿孔性阑尾炎为5.4天（p<0.05）。高龄对临床诊断、疾病阶段和结果产生不利影响。就诊延迟、诊断延误、穿孔的存在以及合并症与手术预后不良相关。
