Berry J, Malt R A
Ann Surg. 1984 Nov;200(5):567-75. doi: 10.1097/00000658-198411000-00002.
In an analysis of the first 72 cases treated after the formulation of the appendicitis syndrome in 1886 compared with the experience from 1929-1959 and with 307 randomly selected recent cases, the major therapeutic trend has been an emphasis on appendectomy before perforation and abscess formation occur. The rate of infection nonetheless remains approximately 17%. Although the overall mortality rate has declined from 26% overall (40% for surgery) to 0.8%, the current rate of perforation is 28%, with a diagnostic accuracy of 82%. Among 13,848 patients from several reports the perforation rate increases linearly with diagnostic accuracy; therefore, a balance must be sought. Delay awaiting a diagnosis is a major determinant of perforation, but diagnostic aids are of limited help. Clinical acuity and prudent decisiveness are the keys to proper action.
在对1886年阑尾炎综合征形成后治疗的首批72例病例进行分析时，将其与1929年至1959年的经验以及307例近期随机选取的病例进行比较，主要治疗趋势是强调在穿孔和脓肿形成之前进行阑尾切除术。然而，感染率仍约为17%。尽管总体死亡率已从总体的26%（手术死亡率为40%）降至0.8%，但目前的穿孔率为28%，诊断准确率为82%。在几份报告中的13848例患者中，穿孔率随诊断准确率呈线性增加；因此，必须寻求平衡。等待诊断的延迟是穿孔的主要决定因素，但诊断辅助手段帮助有限。临床敏锐度和审慎的决断力是采取正确行动的关键。
