Kartal Kinyas, Yazıcı Pınar, Ünlü Taner Mehmet, Uludağ Mehmet, Mihmanlı Mehmet
Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul-Turkey.
Ulus Travma Acil Cerrahi Derg. 2017 Mar;23(2):134-138. doi: 10.5505/tjtes.2016.79328.
Clinical diagnosis of acute appendicitis is based primarily on symptoms and physical findings. However, diagnosis of appendicitis is not always straightforward. The aim of this study was to demonstrate the diagnostic effectiveness of ultrasonography (US) in these cases in combination with white blood cell count (WBC) and C-reactive protein (CRP) level.
Retrospective analysis of data collected on 470 consecutive patients who underwent appendectomy at the same institution between January 2014 and January 2016 was conducted. Data included demographic features, preoperative WBC and CRP levels, and US measurement of diameter of appendix. Patients were divided into 3 groups: lymphoid hyperplasia (LH), non-complicated acute appendicitis (NCAA), and complicated acute appendicitis (CAA), according to postoperative histopathological examination results.
There were 331 male and 139 female patients with mean age of 32.29±11.44 years included in the study. Mean WBC level was 12.31103/µL (±4.47 103/µL), 13.3 103/µL (±3.87 103/µL) and 14.08 103/µL (±4.11 103/µL) in LH, NCAA, and CAA groups, respectively (p=0.016). Mean CRP level was 14.2±19 mg/L, 36.9±59 mg/L, and 40.8±66 mg/L in LH, NCAA, and CAA groups, respectively (p=0.008). Mean outer diameter of the vermiform appendix on US was 4.8 mm (±3.9 mm), 6.9 mm (±4.08 mm) and 7.6 mm (±3.92 mm) in LH, NCAA, and CAA groups, respectively (p<0.01). When all variables were compared with each other, there were statistically significant differences in US findings according to group.
WBC count and CRP level were higher in patients with acute appendicitis, but these findings alone were insufficient for definitive diagnosis. US findings were effectual both in diagnosis and demonstration of severe inflammation. US should be combined with laboratory tests and used as standard initial imaging in diagnostic pathway of patients with clinically suspected appendicitis. The authors of this study believe that this diagnostic pathway will reduce negative appendectomy rate.
急性阑尾炎的临床诊断主要基于症状和体格检查结果。然而，阑尾炎的诊断并非总是一目了然。本研究的目的是证明超声检查（US）联合白细胞计数（WBC）和C反应蛋白（CRP）水平在这些病例中的诊断有效性。
对2014年1月至2016年1月在同一机构接受阑尾切除术的470例连续患者收集的数据进行回顾性分析。数据包括人口统计学特征、术前WBC和CRP水平以及阑尾直径的超声测量值。根据术后组织病理学检查结果，将患者分为3组：淋巴组织增生（LH）、非复杂性急性阑尾炎（NCAA）和复杂性急性阑尾炎（CAA）。
本研究纳入331例男性和139例女性患者，平均年龄为32.29±11.44岁。LH组、NCAA组和CAA组的平均WBC水平分别为12.3×10³/µL（±4.47×10³/µL）、13.3×10³/µL（±3.87×10³/µL）和14.08×10³/µL（±4.11×10³/µL）（p = 0.016）。LH组、NCAA组和CAA组的平均CRP水平分别为14.2±19mg/L、36.9±59mg/L和40.8±66mg/L（p = 0.008）。LH组、NCAA组和CAA组超声检查显示的阑尾平均外径分别为4.8mm（±3.9mm）、6.9mm（±4.08mm）和7.6mm（±3.92mm）（p<0.01）。当所有变量相互比较时，根据分组不同，超声检查结果存在统计学显著差异。
急性阑尾炎患者的WBC计数和CRP水平较高，但仅凭这些结果不足以做出明确诊断。超声检查结果在诊断和显示严重炎症方面均有效。超声应与实验室检查相结合，并作为临床疑似阑尾炎患者诊断途径中的标准初始影像学检查。本研究的作者认为，这种诊断途径将降低阴性阑尾切除率。
