Champault G, Rizk N, Ziol M, Taffinder N, Catheline J M
Service de Chirurgie Générale et Digestive, Université Paris XIII, UFR de Médecine de Bobigny-Bondy, Hôpital Jean Verdier, Bondy.
J Chir (Paris). 1996 Nov;133(7):320-3.
In a prospective study of 81 patients, the appendix was photographed during a laparoscopy performed for pain in the right iliac fossa. An appendicectomy was performed in 65 patients, for the remaining 16, another cause for the pain was found and the appendix was left in place. The evaluation of the photographed appendix was formed afterwards by a group of 10 surgeons and compared with the histopathological results. In 20 cases (30%) the appendix was normal. In 7 (10%) minimal mucosal inflammation was found and in 38 (60%) acute appendicitis. All the surgeons correctly recognised acute appendicitis. The accuracy of recognition of a normal appendix was 70% overall, and the maximum risk of leaving an early form of appendicitis to evolve was 14%. We propose not removing an appendix judged to be normal during laparoscopy if no other cause for the pain is found. A short course of antibiotics would cover the low risk of allowing a very early appendicitis to develop.
在一项针对81例患者的前瞻性研究中，在因右下腹疼痛进行腹腔镜检查时对阑尾进行了拍照。65例患者接受了阑尾切除术，其余16例患者发现了疼痛的其他原因，阑尾被保留。之后由10名外科医生对拍摄的阑尾进行评估，并与组织病理学结果进行比较。20例（30%）阑尾正常。7例（10%）发现轻微黏膜炎症，38例（60%）为急性阑尾炎。所有外科医生均正确识别出急性阑尾炎。正常阑尾识别的总体准确率为70%，任由早期阑尾炎发展的最大风险为14%。我们建议，如果未发现疼痛的其他原因，在腹腔镜检查时不要切除被判定为正常的阑尾。短期使用抗生素可应对任由极早期阑尾炎发展的低风险情况。
