CT 诊断为单纯性阑尾炎后的穿孔率。
Perforation rate after a diagnosis of uncomplicated appendicitis on CT.
出版信息
BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa034.
BACKGROUND
Appendicectomy is a common emergency operation. The aim of this analysis was to study the effect of preoperative delay on disease progression, and whether a novel scoring system (Atema score) could be useful in predicting complicated appendicitis.
METHODS
Patients with uncomplicated acute appendicitis on CT and who underwent appendicectomy in 2014-2015 were analysed for patient characteristics, preoperative delay and outcomes.
RESULTS
Of 837 patients with uncomplicated appendicitis on CT, 187 (22.3 per cent) were found to have complicated appendicitis at surgery. The median time estimate for perforation was 25.4 h after CT, with an hourly rate of perforation of 2 per cent. Patients with an Atema score of 6 or less and those with no appendicolith on CT and a C-reactive protein level below 51 mg/l were the slowest to develop perforation, reaching a perforation rate of 5 per cent in 7.1 and 7.6 h respectively.
CONCLUSION
A substantial proportion of patients with uncomplicated acute appendicitis on CT have complicated appendicitis at surgery. However, in patients with no risk factors, surgery can be postponed safely for up to 7 h.
背景
阑尾切除术是一种常见的急诊手术。本分析旨在研究术前延迟对疾病进展的影响，以及新的评分系统（Atema 评分）是否可用于预测复杂阑尾炎。
方法
对 2014 年至 2015 年 CT 诊断为单纯性急性阑尾炎且行阑尾切除术的患者进行了患者特征、术前延迟和结局分析。
结果
在 837 例 CT 诊断为单纯性阑尾炎的患者中，187 例（22.3%）在手术中发现为复杂性阑尾炎。穿孔的中位时间估计为 CT 后 25.4 小时，穿孔的每小时发生率为 2%。Atema 评分≤6 分且 CT 无阑尾结石且 C 反应蛋白水平＜51mg/L 的患者穿孔最慢，穿孔率分别为 7.1 小时和 7.6 小时时的 5%。
结论
相当一部分 CT 诊断为单纯性急性阑尾炎的患者在手术中存在复杂性阑尾炎。然而，在无风险因素的患者中，手术可安全推迟长达 7 小时。
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