夏洛特·马克斯凯 Johannesburg 学术医院的阴性阑尾切除术率——10 年回顾。
The negative appendicectomy rate at Charlotte Maxeke Johannesburg Academic Hospital - a 10-year review.
机构信息
Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, South Africa.
Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
出版信息
S Afr J Surg. 2022 Mar;60(1):4-9.
BACKGROUND
The negative appendicectomy rate (NAR) is defined as the proportion of surgically removed appendices that are pathologically normal. The acceptable NAR has been a debated issue. Previously, a higher rate was accepted, whilst newer thinking favours a lower rate. Diagnosing appendicitis is often a clinical challenge and may require crosssectional imaging to assist in the diagnosis.
METHODS
A retrospective review was conducted at the Charlotte Maxeke Johannesburg Academic Hospital. Appendix histopathological reports were retrieved for patients older than 18 years over a 10-year period. Reports of ultrasound (US) and/or computed tomography (CT) scans were analysed in the last 18 months.
RESULTS
One thousand two hundred and seventeen appendicectomy specimens were included. The overall NAR was 19%. This demonstrated a significant downward trend over the period ( < 0.003). Per gender, the female NAR showed a significant decline ( = 0.002) while the male decline was not significant ( = 0.517). Reproductive-age females were found to have significantly higher NAR as compared to other age groups. The overall perforation rate was 17% which demonstrated a significant increase over the study period ( = 0.012). In the last 18 months, 240 appendicectomies were performed. One hundred and eleven patients underwent imaging (46%), of which 78 underwent ultrasound (70%), 14 CT (13%) and 19 US and CT (17%).
CONCLUSION
The overall NAR declined significantly over the period. Females under the age of 45 were found to have significantly higher NARs. Further prospective studies are needed to determine the benefit and feasibility of preoperative CT in resource-limited settings, particularly in reproductive-age females to reduce the NAR.
背景
阴性阑尾切除术率（NAR）定义为病理正常的切除阑尾的比例。可接受的 NAR 一直是一个有争议的问题。以前，接受的比率较高，而新的想法倾向于较低的比率。诊断阑尾炎通常是一个临床挑战，可能需要进行横断面成像以协助诊断。
方法
在夏洛特·马克斯凯 Johannesburg 学术医院进行了回顾性研究。在过去 10 年中，检索了 18 岁以上患者的阑尾组织病理学报告。分析了过去 18 个月的超声（US）和/或计算机断层扫描（CT）扫描报告。
结果
共纳入 1217 例阑尾切除术标本。总的 NAR 为 19%。这表明在该期间呈显著下降趋势（<0.003）。按性别划分，女性 NAR 显著下降（=0.002），而男性下降不显著（=0.517）。生殖年龄女性的 NAR 明显高于其他年龄组。总的穿孔率为 17%，在研究期间呈显著上升趋势（=0.012）。在过去的 18 个月中，进行了 240 例阑尾切除术。111 例患者进行了影像学检查（46%），其中 78 例行超声检查（70%），14 例行 CT（13%），19 例行超声和 CT（17%）。
结论
在该期间，总的 NAR 显著下降。45 岁以下的女性发现 NAR 明显更高。需要进一步进行前瞻性研究，以确定在资源有限的环境中术前 CT 的益处和可行性，特别是在生殖年龄的女性中，以降低 NAR。
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