Senbanjo R O
Department of Surgery, General Hospital, Sarat Abeidah, Kingdom of Saudi Arabia.
J R Coll Surg Edinb. 1997 Apr;42(2):85-8.
A prospective study of 418 patients referred with a tentative diagnosis of acute appendicitis was carried out to evaluate the conservative approach in patients with equivocal clinical features. One hundred and six patients (25.4%) with unequivocal signs had immediate appendicectomy. Of the remaining 312 patients, 167 were admitted to hospital for observation. Appendicectomy was performed in 28 of these patients due to progression of clinical signs during the observation period. A total of 134 patients (32%) underwent appendicectomy with an accuracy rate of 84.3%, negative laparotomy rate of 9.7% and perforation rate of 19.4%. One hundred and thirty-six patients (32.5%) with alternative diagnosis received appropriate treatment. The remaining patients improved without any specific therapy. At follow-up, recurrent symptoms requiring appendicectomy occurred in eight patients (5.4%) and appendicitis was confirmed in five (3.4%). Active observation before the decision to operate is a safe and effective approach to the management of patients with equivocal features of acute appendicitis.
对418例初步诊断为急性阑尾炎的患者进行了一项前瞻性研究，以评估对临床特征不明确的患者采用保守治疗方法的效果。106例（25.4%）体征明确的患者立即接受了阑尾切除术。其余312例患者中，167例入院观察。其中28例患者在观察期间因临床体征进展而接受了阑尾切除术。共有134例患者（32%）接受了阑尾切除术，准确率为84.3%，阴性剖腹探查率为9.7%，穿孔率为19.4%。136例（32.5%）有其他诊断的患者接受了适当治疗。其余患者未经任何特殊治疗病情好转。随访时，8例患者（5.4%）出现需要阑尾切除术的复发症状，5例（3.4%）确诊为阑尾炎。在决定手术前进行积极观察是处理急性阑尾炎特征不明确患者的一种安全有效的方法。
