预测阑尾炎患者中的阑尾肿瘤。
Predicting appendiceal tumors among patients with appendicitis.
作者信息
Loftus Tyler J, Raymond Steven L, Sarosi George A, Croft Chasen A, Smith R Stephen, Efron Philip A, Moore Frederick A, Brakenridge Scott C, Mohr Alicia M, Jordan Janeen R
机构信息
From the Department of Surgery (T.J.L., S.L.R., G.A.S., C.A.C., R.S.S., P.A.E., F.A.M., S.C.B., A.M.M., J.R.J.), University of Florida Health; Malcom Randall Veterans Affairs Medical Center (G.A.S.), Gainesville; and Orange Park Medical Center (J.R.J.), Jacksonville, Florida.
出版信息
J Trauma Acute Care Surg. 2017 Apr;82(4):771-775. doi: 10.1097/TA.0000000000001378.
BACKGROUND
As nonoperative management of appendicitis gains popularity, vigilance for appendiceal tumors becomes increasingly important. We hypothesized that, among patients presenting with acute appendicitis, those with advanced age, multiple comorbidities, atypical presentation, and complicated appendicitis would be more likely to have underlying appendiceal tumors.
METHODS
We performed a 4-year retrospective cohort analysis of 677 consecutive adult patients who underwent appendectomy for appendicitis at our tertiary care center. Patients with an appendiceal tumor on their final pathology report were compared to patients with no tumor. Conditions present on admission were used to create a multivariate logistic regression model to predict appendiceal tumor. Risk factors were reported as odds ratio (OR) [95% CI]. Model strength was assessed by area under the receiver operating characteristic curve.
RESULTS
Seventeen patients (2.5%) had an appendiceal tumor. Within this group. 14 underwent immediate appendectomy, two initially had nonoperative management but failed to improve on antibiotics and underwent appendectomy during the initial admission, and one had successful nonoperative management and elective appendectomy 19 days after discharge. Four variables contributed to the multivariate model to predict the presence appendiceal tumor: age ≥ 50 (OR 3.6 [1.1-11.4]), outpatient steroid/immunosuppressant use (OR 12.1 [2.0-72.5]), the absence of migratory right lower quadrant pain (OR 4.7 [1.2-18.1]), and the appearance of a phlegmon on CT scan (OR 7.0 [1.6-30.2]); model area under the receiver operating characteristic curve: 0.860 [0.705-0.969].
CONCLUSION
For patients presenting with acute appendicitis, conditions present on admission may predict underlying appendiceal tumor. Patients with advanced age, multiple comorbidities, atypical presentation, and complicated appendicitis should be considered for appendectomy during the index admission or at earliest convenience if nonoperative management is necessary.
LEVEL OF EVIDENCE
Prognostic study, level III.
背景
随着阑尾炎非手术治疗越来越普遍，对阑尾肿瘤的警惕性变得越发重要。我们推测，在表现为急性阑尾炎的患者中，年龄较大、合并多种疾病、表现不典型以及阑尾炎复杂的患者更有可能存在潜在的阑尾肿瘤。
方法
我们对在我们三级医疗中心因阑尾炎接受阑尾切除术的677例连续成年患者进行了为期4年的回顾性队列分析。将最终病理报告显示有阑尾肿瘤的患者与无肿瘤的患者进行比较。利用入院时存在的情况创建多因素逻辑回归模型来预测阑尾肿瘤。危险因素以比值比（OR）[95%置信区间]报告。通过受试者工作特征曲线下面积评估模型强度。
结果
17例患者（2.5%）有阑尾肿瘤。在该组中，14例接受了急诊阑尾切除术，2例最初采用非手术治疗，但抗生素治疗无效，在首次入院期间接受了阑尾切除术，1例非手术治疗成功，出院19天后接受了择期阑尾切除术。四个变量纳入多因素模型以预测阑尾肿瘤的存在：年龄≥50岁（OR 3.6 [1.1 - 11.4]）、门诊使用类固醇/免疫抑制剂（OR 12.1 [2.0 - 72.5]）、无转移性右下腹疼痛（OR 4.7 [1.2 - 18.1]）以及CT扫描显示有炎性肿块（OR 7.0 [1.6 - 30.2]）；受试者工作特征曲线下面积：0.860 [0.705 - 0.969]。
结论
对于表现为急性阑尾炎的患者，入院时的情况可能预测潜在的阑尾肿瘤。对于年龄较大、合并多种疾病、表现不典型以及阑尾炎复杂的患者，如果需要非手术治疗，应在首次入院期间或尽早考虑进行阑尾切除术。
证据水平
预后研究，III级。
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