Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan; Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Tokyo, Japan.
Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan.
J Surg Res. 2022 Dec;280:179-185. doi: 10.1016/j.jss.2022.06.009. Epub 2022 Aug 18.
Appendicolith causes acute appendicitis. However, surgical indications for appendicolith-related acute appendicitis have not been established. We aimed to clarify the clinical features of appendicolith-associated appendicitis and determine an appropriate treatment strategy based on the initial presentation.
We retrospectively reviewed the records of 479 consecutive patients with acute appendicitis and verified the therapeutic strategy as per the appendicolith and clinical status.
Appendicoliths were identified in 214 of 479 patients (44.6%) using computed tomography. Surgery was more frequently required in patients with appendicolith than in patients without appendicolith (82.7 versus 64.9%; P < 0.001). The stones were smaller and serum C-reactive protein (CRP) concentration was lower among patients with appendicoliths treated with medication alone than among those surgically treated (both P < 0.001). An appendicolith measuring ≤5 mm in diameter and CRP concentration ≤5.36 mg/dL were predictive of completion of nonsurgical therapy. CRP concentration >10 mg/dL and stone diameter of 10 mm were significantly associated with appendiceal perforation.
Nonsurgical therapy could be considered for patients with appendicoliths measuring ≤5 mm in diameter and in cases where the serum CRP concentration is ≤5 mg/dL. An appendicolith measuring >10 mm in diameter or CRP concentration >10 mg/dL is an indication for surgery.
阑尾结石可引起急性阑尾炎。然而，阑尾结石相关急性阑尾炎的手术指征尚未确定。我们旨在根据初始表现阐明阑尾结石相关阑尾炎的临床特征，并确定适当的治疗策略。
我们回顾性分析了 479 例连续急性阑尾炎患者的记录，并根据阑尾结石和临床状况验证了治疗策略。
在 479 例患者中，通过计算机断层扫描发现 214 例（44.6%）有阑尾结石。与无阑尾结石的患者相比，有阑尾结石的患者更需要手术（82.7%比 64.9%；P<0.001）。单独使用药物治疗的患者结石较小，血清 C 反应蛋白（CRP）浓度较低（均 P<0.001）。阑尾结石直径≤5mm 和 CRP 浓度≤5.36mg/dL 是完成非手术治疗的预测因素。CRP 浓度>10mg/dL 和结石直径为 10mm 与阑尾穿孔显著相关。
对于直径≤5mm 的阑尾结石患者，以及 CRP 浓度≤5mg/dL 的患者，可以考虑非手术治疗。直径>10mm 的阑尾结石或 CRP 浓度>10mg/dL 是手术的指征。
