外科医生的判断对急性阑尾炎诊断的影响。
Effect of surgeon's judgement on the diagnosis of acute appendicitis.
作者信息
Hasbahçeci Mustafa, Erol Cengiz, Törü Mustafa, Şeker Mehmet
机构信息
Department of General Surgery, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey.
Department of Radiology, Faculty of Medicine, İstanbul Medipol University, İstanbul, Turkey.
出版信息
Ulus Cerrahi Derg. 2014 Mar 1;30(1):22-7. doi: 10.5152/UCD.2014.2582. eCollection 2014.
OBJECTIVE
The accuracy of a surgeon's judgement still remains to be controversial in the diagnosis of acute appendicitis, which is a diagnosis usually based on laboratory data and imaging tests.
MATERIAL AND METHODS
Patients with a possible diagnosis of acute appendicitis were reviewed retrospectively with regard to demographic variables, laboratory and imaging results, and treatment modalities.
RESULTS
There were 128 patients with a mean age of 31.2±14 years. The mean white blood cell count and the proportion of polymorphonuclear leukocytes were 11403±4669/mm(3) and 75±11%, respectively. Appendectomy was performed on 66 (51.6%) patients. Conservative management was applied to 62 (48.4%) patients. Statistical analysis showed that patients with appendicitis have a higher white blood cell count (p=0.015) and a higher proportion of polymorphonuclear leukocytes (p=0.023). Sensitivity, specificity and accuracy rates were 84.6%, 63.7% and 74.3% for ultrasound and 100%, 86.7% and 92.2% for computed tomography, respectively.
CONCLUSION
Diagnosis based on patients' laboratory and imaging data, in combination with, the surgeon's judgement appears to yield the best outcomes in patients with suspicion of acute appendicitis.
目的
在急性阑尾炎的诊断中，外科医生判断的准确性仍存在争议，急性阑尾炎的诊断通常基于实验室数据和影像学检查。
材料与方法
对可能诊断为急性阑尾炎的患者进行回顾性研究，分析其人口统计学变量、实验室和影像学结果以及治疗方式。
结果
共有128例患者，平均年龄为31.2±14岁。平均白细胞计数和多形核白细胞比例分别为11403±4669/mm³和75±11%。66例（51.6%）患者接受了阑尾切除术。62例（48.4%）患者采用了保守治疗。统计分析表明，阑尾炎患者的白细胞计数更高（p=0.015），多形核白细胞比例更高（p=0.023）。超声检查的敏感性、特异性和准确率分别为84.6%、63.7%和74.3%，计算机断层扫描的敏感性、特异性和准确率分别为100%、86.7%和92.2%。
结论
对于疑似急性阑尾炎的患者，结合患者的实验室和影像学数据以及外科医生的判断进行诊断，似乎能取得最佳治疗效果。
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