Deiters Alyssa, Drozd Andrew, Parikh Priti, Markert Ronald, Shim Joon K
Am Surg. 2019 Apr 1;85(4):397-402.
The purpose of this study was to determine whether the Alvarado score is beneficial in identifying complicated uncomplicated acute appendicitis in elderly patients. A retrospective review was conducted of patients aged 65 years and older who underwent an appendectomy for pathologically confirmed appendicitis. A review of 310 operative reports and patient charts from October 2012 to December 2016 yielded 216 patients. Patients were grouped based on complicated uncomplicated appendicitis. One hundred ten patients had complicated appendicitis, whereas 106 patients were uncomplicated. Among the complicated appendicitis patients, 76.4 per cent were perforated, 38.2 per cent were gangrenous, and 34.5 per cent had an abscess. The complicated appendicitis group had a higher mean duration of symptoms (2.70 ± 3.41 days 2.09 ± 3.08 days, = 0.011). Appendectomies that were open or converted to open were more likely to be associated with complicated appendicitis (75% 48%, = 0.012). Mean hospital length of stay was greater in those with complicated appendicitis (5.34 ± 5.56 days 3.12 ± 2.86 days, < 0.001). The two groups did not differ on mean Alvarado score (complicated = 6.96 ± 1.99 uncomplicated = 6.72 ± 1.85, = 0.36). Only 62.5 per cent of patients had an Alvarado score that met the cutoff for acute appendicitis. The Alvarado score was not able to differentiate complicated from uncomplicated appendicitis in elderly patients.
本研究的目的是确定阿尔瓦拉多评分是否有助于鉴别老年患者复杂及非复杂急性阑尾炎。对65岁及以上因病理确诊阑尾炎而接受阑尾切除术的患者进行了回顾性研究。回顾2012年10月至2016年12月期间的310份手术报告和患者病历，共纳入216例患者。根据阑尾炎是否复杂对患者进行分组。110例患者为复杂阑尾炎，而106例患者为非复杂阑尾炎。在复杂阑尾炎患者中，76.4%为穿孔性，38.2%为坏疽性，34.5%有脓肿形成。复杂阑尾炎组症状的平均持续时间更长（2.70±3.41天对2.09±3.08天，P = 0.011）。开腹或转为开腹的阑尾切除术更可能与复杂阑尾炎相关（75%对48%，P = 0.012）。复杂阑尾炎患者的平均住院时间更长（5.34±5.56天对3.12±2.86天，P<0.001）。两组患者的阿尔瓦拉多评分均值无差异（复杂组 = 6.96±1.99，非复杂组 = 6.72±1.85，P = 0.36）。只有62.5%的患者阿尔瓦拉多评分达到急性阑尾炎的临界值。阿尔瓦拉多评分无法区分老年患者的复杂和非复杂阑尾炎。
