Özdamar Mustafa Yaşar, Karavaş Erdal
Department of Pediatric Surgery, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey.
Department of Radiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey.
Arch Med Sci. 2018 Nov 8;16(2):313-320. doi: 10.5114/aoms.2018.79430. eCollection 2020.
Diagnostic discrimination between acute appendicitis (AA) and mesenteric lymphadenitis (AML) may require more diagnostic tests or great skill after excluding other diagnoses. This study aimed to make a differential diagnosis between AA and AML patients with previous and new parameters and to examine which parameters should be taken into account regarding whether the AML patient should be hospitalized or discharged.
One hundred and twenty-three AML and 134 AA patients, randomly selected, were included in the study. Demographic, clinical, and laboratory data of all subjects were analyzed. Ultrasonographic and rarely computed tomography examinations evaluating for the enlarged lymph nodes with the shortest diameter in the right lower quadrant of the AML patients were performed. Also, the erect abdominal radiographs (EAR) of AML and AA patients were evaluated.
While there was no statistically significant difference in age or gender, C-reactive protein, white blood cell count, monocyte percentage as well as symptoms between the AA and AML groups ( > 0.05), neutrophil and lymphocyte percentage, appearance of EAR and L/M ratio were significantly different between the two groups ( < 0.05). There was no correlation between the short-axis diameter of the mesenteric lymph node and clinical and laboratory findings in the AML group ( > 0.05).
Based on the results with ROC curve analysis, we propose to take into account the L/M ratio and the EAR from the parameters in the differential diagnosis between AA and AML in addition to previously reported parameters. Also, we recommend that the same features may be used to decide whether AML patients under observation are hospitalized or not.
在排除其他诊断后，鉴别急性阑尾炎（AA）和肠系膜淋巴结炎（AML）可能需要更多的诊断测试或高超的技能。本研究旨在通过既往和新的参数对AA和AML患者进行鉴别诊断，并研究在决定AML患者应住院还是出院时应考虑哪些参数。
随机选取123例AML患者和134例AA患者纳入研究。分析了所有受试者的人口统计学、临床和实验室数据。对AML患者右下腹最短直径的肿大淋巴结进行超声检查，很少进行计算机断层扫描检查。此外，还对AML和AA患者的立位腹部X线片（EAR）进行了评估。
AA组和AML组在年龄、性别、C反应蛋白、白细胞计数、单核细胞百分比以及症状方面无统计学显著差异（P>0.05），但两组在中性粒细胞和淋巴细胞百分比、EAR表现及L/M比值方面有显著差异（P<0.05）。AML组肠系膜淋巴结短轴直径与临床和实验室检查结果之间无相关性（P>0.05）。
基于ROC曲线分析结果，我们建议在AA和AML的鉴别诊断中，除了先前报道的参数外，还应考虑L/M比值和EAR。此外，我们建议可以使用相同的特征来决定观察中的AML患者是否住院。
