Golladay E S, Sarrett J R
Department of Surgery, University of Arkansas for Medical Sciences, Little Rock.
South Med J. 1988 Jan;81(1):38-42. doi: 10.1097/00007611-198801000-00008.
Delay in appendectomy occurs from failure to contact a physician, or from a physician's failure to make a proper diagnosis. In our study delay was due to physician error in 32 of 422 children who had appendectomy. Symptoms consistent with appendicitis were documented on the initial visit in each case, but 22 patients had a history of previous similar pain or recent viral illness to confuse the diagnosis. Misdiagnosis was responsible for the delay in 14 cases (gastroenteritis in ten and urinary tract infection in four). Antibiotics given before proper diagnosis in 22 instances increased diagnostic difficulty in 20. Late referral is increasing, perhaps because of a perceived innocuous nature of appendicitis. Complicated appendicitis was found in 26 children (81%), compared with 38% of the total experience. Their hospital stay averaged nine days, as opposed to 6.6 days in the nondelayed group. Failure of resolution of symptoms after therapy begins mandates reassessment to avoid progression of this common surgical disease.
阑尾切除术的延迟发生于未能联系医生，或医生未能做出正确诊断。在我们的研究中，422例行阑尾切除术的儿童中有32例延迟是由于医生的失误。每例患者初次就诊时均记录有与阑尾炎相符的症状，但22例患者有既往类似疼痛病史或近期病毒感染病史，从而混淆了诊断。误诊导致14例延迟（10例为肠胃炎，4例为尿路感染）。22例在正确诊断前使用了抗生素，其中20例增加了诊断难度。延迟转诊在增加，可能是因为人们认为阑尾炎性质无害。26名儿童（81%）发现有复杂性阑尾炎，而在总体病例中这一比例为38%。他们的住院时间平均为9天，而非延迟组为6.6天。治疗开始后症状未缓解，必须重新评估，以避免这种常见外科疾病的进展。
