Sarfati M R, Hunter G C, Witzke D B, Bebb G G, Smythe S H, Boyan S, Rappaport W D
Department of Surgery, University of Arizona Health Sciences Center, Tucson 85724.
Am J Surg. 1993 Dec;166(6):660-4; discussion 664-5. doi: 10.1016/s0002-9610(05)80675-0.
The diagnosis of acute appendicitis is usually made from the history and physical examination. Recently, abdominal ultrasonography (US), laparoscopy, computerized tomography (CT), and barium enema (BE) have been used in the preoperative evaluation of patients with presumed appendicitis in order to improve the diagnostic accuracy. However, the usefulness of these tests in verifying the diagnosis of appendicitis has not been established. We reviewed the medical records of 203 patients who underwent appendectomy. One hundred patients were surgically treated before 1984 (group I) and 103 patients underwent surgery after 1988 (group II). Patients in group II were more likely to have preoperative US, laparoscopy, CT, or BE (24 in group II versus 3 in group I, p < 0.05). When groups I and II were compared, the rates of perforation (27% versus 20%), normal appendectomy (8% versus 11%), and the interval between admission and operation (12.2 hours versus 10.7 hours) and length of hospitalization (5.0 days versus 5.1 days) were not significantly different. We concluded that although adjunctive testing may be beneficial in selected patients, its routine use in patients suspected of having appendicitis cannot be advocated at present.
急性阑尾炎的诊断通常依据病史和体格检查做出。近来，腹部超声检查（US）、腹腔镜检查、计算机断层扫描（CT）以及钡剂灌肠（BE）已被用于对疑似阑尾炎患者进行术前评估，以提高诊断准确性。然而，这些检查在确诊阑尾炎方面的效用尚未得到证实。我们回顾了203例行阑尾切除术患者的病历。100例患者于1984年前接受手术治疗（第一组），103例患者于1988年后接受手术（第二组）。第二组患者更有可能接受术前US、腹腔镜检查、CT或BE（第二组24例，第一组3例，p<0.05）。比较第一组和第二组时，穿孔率（27%对20%）、正常阑尾切除术率（8%对11%）、入院与手术间隔时间（12.2小时对10.7小时）以及住院时间（5.0天对5.1天）并无显著差异。我们得出结论，尽管辅助检查可能对部分患者有益，但目前不能提倡对疑似阑尾炎患者常规使用。
