Department of Surgery, Tergooi Hospital Hilversum, 10016, 1213 XZ, Hilversum, The Netherlands.
Department of Surgery, Maasstad Hospital Rotterdam, 9100, 3007 AC, Rotterdam, The Netherlands.
J Gastrointest Surg. 2020 Sep;24(9):2088-2095. doi: 10.1007/s11605-019-04345-3. Epub 2019 Aug 13.
To identify discrepancies between intraoperative and histological evaluations of the appendix in acute appendicitis and to evaluate the effect on surgical outcome.
Data was used from our previous multicentre, prospective, cohort study of patients with suspected acute appendicitis. Appendices were scored during intraoperative and histological evaluation as uncomplicated or complicated appendicitis. Primary outcome was percentage of concordance between intraoperative and histological evaluation. Secondary outcomes were (infectious) postoperative complications, length of hospital stay, hospital re-admission and re-intervention rate, all within 30 days of surgery.
A total of 1850 patients were included. In 65.7% (1215/1850) of the appendices, the intraoperative evaluation was uncomplicated and in 34.3% (635/1850), complicated appendicitis. Patients with uncomplicated appendicitis had a postoperative course with significantly less postoperative complications (7.2% vs 24.3%), a shorter length of hospital stay (2 vs 5 days) and a lower re-admission (4.2% vs 9.6%) and re-intervention rate (1.1% vs 4.3%) than intraoperative complicated appendicitis (p < 0.001). In 93.5% (1136/1215) of the intraoperative uncomplicated patients and in 46.6% (296/635) of the intraoperative complicated patients, there was an agreement with pathology (Kappa 0.45). In 23.9% (81/339) of patients with intraoperative complicated and histological uncomplicated appendicitis, a postoperative complication was observed, which was similar to the postoperative complication rate of complicated appendicitis both on intraoperative and histological evaluation (24.7% (73/296)).
There is a moderate agreement between a surgeon and pathologist in diagnosing patients with complicated appendicitis. However, the intraoperative diagnosis of complicated appendicitis was significantly associated with postoperative complications. Routine histological evaluation should be preserved for excluding malignancies in suspect appendices.
确定急性阑尾炎手术中和组织学评估之间的差异，并评估其对手术结果的影响。
本研究使用了我们之前多中心前瞻性队列研究中疑似急性阑尾炎患者的数据。术中评估和组织学评估中，阑尾评分将阑尾分为单纯性或复杂性阑尾炎。主要结局是术中评估与组织学评估的一致性百分比。次要结局是（感染）术后并发症、住院时间、住院再入院率和再干预率，均在术后 30 天内。
共纳入 1850 例患者。在 65.7%（1215/1850）的阑尾中，术中评估为单纯性，34.3%（635/1850）为复杂性阑尾炎。单纯性阑尾炎患者术后并发症明显较少（7.2% vs 24.3%），住院时间较短（2 天 vs 5 天），再入院率（4.2% vs 9.6%）和再干预率（1.1% vs 4.3%）均低于术中复杂性阑尾炎（p<0.001）。在 93.5%（1136/1215）的术中单纯性患者和 46.6%（296/635）的术中复杂性患者中，病理结果与术中评估结果一致（Kappa 值为 0.45）。在 23.9%（81/339）的术中复杂性和组织学单纯性阑尾炎患者中观察到术后并发症，这与术中评估和组织学评估的复杂性阑尾炎术后并发症发生率相似（24.7%（73/296））。
外科医生和病理学家在诊断复杂性阑尾炎患者方面存在中等程度的一致性。然而，术中诊断复杂性阑尾炎与术后并发症显著相关。对于可疑阑尾，应保留常规组织学评估以排除恶性肿瘤。
