Department of Surgery, Amsterdam UMC, location AMC, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Amsterdam, The Netherlands.
Department of Surgery, University of Turku, Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.
Scand J Surg. 2021 Jun;110(2):170-179. doi: 10.1177/14574969211008330. Epub 2021 Apr 14.
Diagnostic work-up of acute appendicitis remains challenging. While some guidelines advise to use a risk stratification based on clinical parameters, others use standard imaging in all patients. As non-operative management of uncomplicated appendicitis has been identified as feasible and safe, differentiation between uncomplicated and complicated appendicitis is of paramount importance. We reviewed the literature to describe the optimal strategy for diagnosis of acute appendicitis.
A narrative review about the diagnosis of acute appendicitis in adult patients was conducted. Both diagnostic strategies and goals were analyzed.
For diagnosing acute appendicitis, both ruling in and ruling out the disease are important. Clinical and laboratory findings individually do not suffice, but when combined in a diagnostic score, a better risk prediction can be made for having acute appendicitis. However, for accurate diagnosis imaging seems obligatory in patients suspected for acute appendicitis. Scoring systems combining clinical and imaging features may differentiate between uncomplicated and complicated appendicitis and may enable ruling out complicated appendicitis. Within conservatively treated patients with uncomplicated appendicitis, predictive factors for non-responsiveness to antibiotics and recurrence of appendicitis need to be defined in order to optimize treatment outcomes.
Standard imaging increases the diagnostic power for both ruling in and ruling out acute appendicitis. Incorporating imaging features in clinical scoring models may provide better differentiation between uncomplicated and complicated appendicitis. Optimizing patient selection for antibiotic treatment of appendicitis may minimize recurrence rates, resulting in better treatment outcomes.
急性阑尾炎的诊断仍然具有挑战性。虽然有些指南建议根据临床参数进行风险分层，但另一些指南则建议对所有患者进行标准影像学检查。由于非手术治疗单纯性阑尾炎已被证明是可行和安全的，因此区分单纯性和复杂性阑尾炎至关重要。我们回顾了文献，以描述急性阑尾炎的最佳诊断策略。
对成人急性阑尾炎的诊断进行了叙述性综述。分析了诊断策略和目标。
对于急性阑尾炎的诊断，疾病的确诊和排除都很重要。临床和实验室检查单独使用都不够，但当组合成诊断评分时，可以更好地预测是否患有急性阑尾炎。然而，对于疑似急性阑尾炎的患者，影像学检查似乎是必不可少的。将临床和影像学特征相结合的评分系统可以区分单纯性和复杂性阑尾炎，并有助于排除复杂性阑尾炎。在接受单纯性阑尾炎保守治疗的患者中，需要明确预测抗生素治疗无反应和阑尾炎复发的因素，以优化治疗结果。
标准影像学检查提高了确诊和排除急性阑尾炎的诊断能力。将影像学特征纳入临床评分模型中可能更好地区分单纯性和复杂性阑尾炎。优化阑尾炎抗生素治疗的患者选择，可能会降低复发率，从而获得更好的治疗效果。
