Nordback I, Harju E
Department of Surgery, University Central Hospital, Tampere, Finland.
Acta Chir Scand. 1988 Jan;154(1):43-8.
The role of the common parameters of inflammation in the diagnosis of acute appendicitis was studied by measuring axillary temperature (Tax), blood leukocyte (Leuk) and lymphocyte fraction (Lymph), serum C-reactive protein (CRP) and ESR in 354 patients with clinical diagnosis of acute appendicitis. Laparotomy showed normal appendix in 97 cases, but deduction of 14 with other surgically correctable disorders gave the negative appendectomy rate 83/354 (23.4%). The appendix had perforated in 9.9%. Tax, Leuk, Lymph and CRP could significantly differentiate acute appendicitis from the other cases, with respective sensitivity (and false positive) percentages 88.7 (66.0), 78.5 (24.7), 84.4 (48.5) and 52.7 (24.7). Although such statistical differences are not particularly helpful in preoperative diagnosis of individual cases, none of the 37 patients with simultaneously normal Leuk, Lymph and CRP had obvious appendicitis (2 probably had incipient inflammation). If laparotomy had not been performed in these 37 cases, almost half of the unnecessary operations could have been avoided, thereby reducing the negative appendectomy rate to 15.2%, with 11.7% perforation rate.
通过测量354例临床诊断为急性阑尾炎患者的腋窝温度（Tax）、血白细胞（Leuk）和淋巴细胞比例（Lymph）、血清C反应蛋白（CRP）和血沉（ESR），研究炎症常见参数在急性阑尾炎诊断中的作用。剖腹手术显示97例阑尾正常，但扣除14例有其他可手术纠正疾病的患者后，阴性阑尾切除率为83/354（23.4%）。阑尾穿孔率为9.9%。Tax、Leuk、Lymph和CRP可显著区分急性阑尾炎与其他病例，各自的敏感性（和假阳性）百分比分别为88.7（66.0）、78.5（24.7）、84.4（48.5）和52.7（24.7）。虽然这些统计学差异对个别病例的术前诊断帮助不大，但37例Leuk、Lymph和CRP同时正常的患者中无一例有明显的阑尾炎（2例可能有早期炎症）。如果这37例未进行剖腹手术，几乎一半的不必要手术可以避免，从而将阴性阑尾切除率降至15.2%，穿孔率为11.7%。
