Tekeli Mehmet Tahsin, Ilhan Enver, Ureyen Orhan, Senlikci Abdullah, Yeldan Eyup, Ozturk Mucteba, Ustuner Mehmet Akif, Gokcelli Ugur, Dadali Emrah, Cengiz Fevzi, Yakan Savas
Department of Surgery, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
Indian J Surg. 2017 Apr;79(2):106-110. doi: 10.1007/s12262-015-1433-2. Epub 2016 Jan 11.
There is still an ongoing debate, especially regarding early diagnosis of acute appendicitis. Early surgery leads to inadequate evaluation of acute abdominal pain and negative appendectomy, whereas delayed surgery leads to appendicitis perforation complications. The diagnosis of this condition is considerably difficult, especially due to subtle early symptoms and clinical condition. The aim of the present study was to identify whether the Alvarado scoring system could reduce the incidence of negative appendectomy in patients who will undergo surgery for acute appendicitis. Patients who underwent surgery with acute appendicitis prediagnosis were retrospectively classified as negative appendectomies (group A) and positive appendectomies (group B) according to histological diagnosis. All groups were evaluated for age, gender, Alvarado scores, and parameters. Two hundred eighty-one patients were included in the study. Group A contained 71 (25.3 %) patients, and group B contained 210 (74.7 %) patients. There was a significant difference in WBC, left shift, rebound, and change of pain localization between the groups ( = 0.002, < 0.001, < 0.001, and = 0.023, respectively). Alvarado scores were significantly different between the groups ( < 0.001). In logistic model examination, the major factor was the Alvarado score (7 or above) and the minor factor was spreading pain. The Alvarado scoring system can be used to reduce negative appendectomy in patients who will undergo surgery with acute appendicitis.
目前仍存在争议，尤其是在急性阑尾炎的早期诊断方面。早期手术会导致对急性腹痛评估不足以及阑尾切除阴性，而延迟手术则会导致阑尾炎穿孔并发症。这种疾病的诊断相当困难，特别是由于早期症状和临床情况较为隐匿。本研究的目的是确定阿尔瓦拉多评分系统是否可以降低将接受急性阑尾炎手术患者的阑尾切除阴性发生率。根据组织学诊断，对预先诊断为急性阑尾炎并接受手术的患者进行回顾性分类，分为阑尾切除阴性组（A组）和阑尾切除阳性组（B组）。对所有组进行年龄、性别、阿尔瓦拉多评分及各项参数评估。281例患者纳入本研究。A组有71例（25.3%）患者，B组有210例（74.7%）患者。两组之间白细胞计数、核左移、反跳痛及疼痛部位变化存在显著差异（分别为P = 0.002、P < 0.001、P < 0.001和P = 0.023）。两组之间阿尔瓦拉多评分有显著差异（P < 0.001）。在逻辑模型检验中，主要因素是阿尔瓦拉多评分（7分及以上），次要因素是疼痛扩散。阿尔瓦拉多评分系统可用于降低将接受急性阑尾炎手术患者的阑尾切除阴性率。
