Youatou Towo P, Ramadan A S E, Ngatchou W, Djiélé J N, Etienne A, Capelluto E, Mols Pr P
Department of Emergency, Saint Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium.
Department of General Surgery, Saint Pierre University Hospital, Brussels, Belgium.
Eur J Trauma Emerg Surg. 2012 Dec;38(6):641-6. doi: 10.1007/s00068-012-0208-8. Epub 2012 Sep 1.
This study analysed the clinical and para-clinical criteria that may allow surgeons and emergency physicians to take a decision regarding the surgery of acute appendicitis.
A retrospective analysis was conducted on 284 acute appendicitis patients who underwent surgery between January 2007 and December 2009 in our institution. The registered data were extracted from patient files and statistically analysed. These data included past medical history, clinical, laboratory and imaging data, duration of hospital stay and post-operative complications. Patient delay (time between the appearance of symptoms and patient arrival at the emergency department) and hospital delay (time between hospital arrival and operation) were correctly investigated. Statistical analysis was done by using SPSS software.
The patient delay is significantly increased in relation to the severity of appendicitis: 24 h (10.8-30.8 h) versus 37.4 h (36.8-38 h) (P < 0.05), unlike hospital delay, which remains constant (between simple and severe appendicitis): 7.5 h (5-14.8 h) versus 8 h (5-13 h). In severe appendicitis, the proportion of guarding, rebound tenderness, tachycardia (P < 0.05) and fever (P < 0.005) were significantly high, and leucocytosis (P < 0.05), C-reactive protein (CRP) (P < 0.001) and eosinopaenia [37.0 vs. 72.8 (P < 0.001)] were significantly different. Concerning computed tomography (CT) and echography, perforation, abscess formation (P < 0.05), phlegmon (P < 0.005) and peritonitis (P < 0.05) were significant signs of complicated cases. The length of hospital stay (P < 0.001) and duration of antibiotic therapy (P < 0.001) were statistically significant in cases of complicated appendicitis.
Patient delay is a determining factor for the grade of appendicitis. It has an influence on the complications, length of hospital stay and duration of antibiotic treatment, unlike hospital delay.
本研究分析了一些临床和辅助临床标准，这些标准可帮助外科医生和急诊医生就急性阑尾炎的手术做出决策。
对2007年1月至2009年12月期间在本院接受手术的284例急性阑尾炎患者进行回顾性分析。从患者病历中提取登记的数据并进行统计分析。这些数据包括既往病史、临床、实验室和影像学数据、住院时间和术后并发症。正确调查了患者延迟（症状出现至患者到达急诊科的时间）和医院延迟（医院到达至手术的时间）。使用SPSS软件进行统计分析。
患者延迟时间随阑尾炎严重程度显著增加：24小时（10.8 - 30.8小时）对比37.4小时（36.8 - 38小时）（P < 0.05），与医院延迟不同，医院延迟保持不变（单纯性与重度阑尾炎之间）：7.5小时（5 - 14.8小时）对比8小时（5 - 13小时）。在重度阑尾炎中，肌紧张、反跳痛、心动过速（P < 0.05）和发热（P < 0.005）的比例显著更高，白细胞增多（P < 0.05）、C反应蛋白（CRP）（P < 0.001）和嗜酸性粒细胞减少[37.0对比72.8（P < 0.001）]有显著差异。关于计算机断层扫描（CT）和超声检查，穿孔、脓肿形成（P < 0.05）、蜂窝织炎（P < 0.005）和腹膜炎（P < 0.05）是复杂病例的显著征象。复杂阑尾炎病例的住院时间（P < 0.001）和抗生素治疗时间（P < 0.001）有统计学意义。
患者延迟是阑尾炎分级的决定因素。与医院延迟不同，它对并发症、住院时间和抗生素治疗时间有影响。
