Sauvain Marc-Olivier, Tschirky Sandra, Patak Michael A, Clavien Pierre-Alain, Hahnloser Dieter, Muller Markus K
Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland ; Department of Visceral Surgery, University Hospital CHUV, Switzerland Rue du Bugnon 46, CH- 1011 Lausanne, Switzerland.
Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
Patient Saf Surg. 2016 May 17;10:13. doi: 10.1186/s13037-016-0102-0. eCollection 2016.
The diagnosis of acute appendicitis in overweight patients is challenging due to the limited value of the clinical examination. The benefits of ultrasonography and abdominal CT have been studied in the general population, but there is limited data regarding their use in overweight and obese patients with suspected appendicitis. This study analyzes the role of preoperative radiological modalities in overweight patients with suspected appendicitis.
Retrospective analysis of a prospectively acquired database including 705 patients operated for suspected acute appendicitis. Patients were divided into two groups according to their BMI (BMI ≥25 kg/m(2) (n = 242) and BMI <25 kg/m(2) (n = 463)). The use of preoperative radiological modalities, laboratory findings and outcome parameters were analyzed.
Ultrasonography was the preferred radiological assessment in our cohort (68 % in BMI <25 kg/m and 52.4 % in BMI ≥25 kg/m(2)). However, it was non-conclusive in 42 % of overweight as compared to 6 % in patients with a BMI < 25 (p < 0.0001). This difference was particularly obvious between female patients (8 % of non-conclusive US for BMI <25 kg/m(2) vs 52 % for BMI ≥25 kg/m(2), p < 0.0001). Significantly more CT scans were performed in overweight patients (37 % vs. 20 %; p <0.0001). The accuracy of CT did not differ according to BMI (85 % vs. 88 %; p = 0.76). Preoperative radiological imaging did not significantly delay surgery. Laparoscopy was the preferred approach for both groups (98.2 % vs 98.7 %, P = 0.86) with an overall conversion rate of 4 %. The overall rate of negative appendectomy was 10 %.
The role of ultrasonography in patients with BMI ≥25 kg/m(2) with suspected acute appendicitis is questionable due to its high rate of non-conclusive findings. Therefore, abdominal CT scans should be preferred to investigate suspected appendicitis in overweight patient if clinical findings are not conclusive.
由于临床检查价值有限，超重患者急性阑尾炎的诊断具有挑战性。超声检查和腹部CT在普通人群中的益处已得到研究，但关于它们在疑似阑尾炎的超重和肥胖患者中的应用数据有限。本研究分析了术前影像学检查方法在疑似阑尾炎超重患者中的作用。
对一个前瞻性收集的数据库进行回顾性分析，该数据库包括705例因疑似急性阑尾炎接受手术的患者。根据BMI将患者分为两组（BMI≥25kg/m²（n = 242）和BMI<25kg/m²（n = 463））。分析术前影像学检查方法的使用情况、实验室检查结果和结局参数。
超声检查是我们队列中首选的影像学评估方法（BMI<25kg/m²组为68%，BMI≥25kg/m²组为52.4%）。然而，超重患者中42%的超声检查结果不明确，而BMI<25的患者中这一比例为6%（p<0.0001）。这种差异在女性患者中尤为明显（BMI<25kg/m²的患者中超声检查结果不明确的比例为8%，而BMI≥25kg/m²的患者中为52%，p<0.0001）。超重患者中进行CT扫描的比例显著更高（37%对20%；p<0.0001）。CT的准确性根据BMI没有差异（85%对88%；p = 0.76）。术前影像学检查未显著延迟手术。腹腔镜检查是两组的首选方法（98.2%对98.7%，P = 0.86），总体中转率为4%。阴性阑尾切除术的总体发生率为10%。
对于BMI≥25kg/m²的疑似急性阑尾炎患者，超声检查的作用值得怀疑，因为其无结论性结果的发生率很高。因此，如果临床检查结果不明确，超重患者疑似阑尾炎时应首选腹部CT扫描进行检查。
