Wagner M, Aronsky D, Tschudi J, Metzger A, Klaiber C
Surgical Department, Spital Aarberg, Switzerland.
Surg Endosc. 1996 Sep;10(9):895-9. doi: 10.1007/s004649900192.
The value of laparoscopic appendectomy remains controversial. Therefore, we investigated the accuracy of diagnostic laparoscopy in detecting acute appendicitis and tested the applicability and safety of stapling appendectomy as a routine procedure.
Data from 267 consecutive patients with suspicion of acute appendicitis were recorded prospectively.
Histopathological examination revealed nonperforated and perforated appendicitis in 63.3% and 13.1%, respectively, and no inflammation in 10.8%. Other pathological findings were observed in 12.7%. Diagnostic laparoscopy detected appendicitis with a sensitivity and specificity of 95.6% and 96.6%, respectively; the positive and negative predictive value were 99.5% and 74.3%, respectively. Morbidity was 10.2% in total and 40% for perforated appendicitis. Planned laparoscopic reexploration reduced morbidity by 23.4% in patients with perforated appendicitis and substantial peritonitis. Mortality was 0.4%.
Laparoscopy improves diagnostic accuracy for acute appendicitis and laparoscopic stapling appendectomy is a safe and efficient procedure for all forms of appendicitis.
腹腔镜阑尾切除术的价值仍存在争议。因此，我们研究了诊断性腹腔镜检查在检测急性阑尾炎方面的准确性，并测试了吻合器阑尾切除术作为常规手术的适用性和安全性。
前瞻性记录了267例连续怀疑患有急性阑尾炎患者的数据。
组织病理学检查显示，非穿孔性阑尾炎和穿孔性阑尾炎分别占63.3%和13.1%，无炎症者占10.8%。其他病理发现占12.7%。诊断性腹腔镜检查检测阑尾炎的敏感性和特异性分别为95.6%和96.6%；阳性和阴性预测值分别为99.5%和74.3%。总发病率为10.2%，穿孔性阑尾炎的发病率为40%。对于穿孔性阑尾炎和严重腹膜炎患者，计划性腹腔镜再次探查使发病率降低了23.4%。死亡率为0.4%。
腹腔镜检查提高了急性阑尾炎的诊断准确性，腹腔镜吻合器阑尾切除术对于所有类型的阑尾炎都是一种安全有效的手术方法。
