Jüngling A, Holzgreve A, Kaiser R
Abteilung für Gefäss-, Thorax- und Viszeralchiurgie, Krankenhaus Neukölln in Berlin.
Zentralbl Chir. 1998;123 Suppl 4:32-7.
From 1.1.1993 to 30.9.1997 1149 patients with right-sided abdominal pain were examined by an experienced sonographer. The specificity of the sonographic diagnosis of acute appendicitis was 98.7%, sensitivity 95.6%, PPV 96.5%, NPV 98.3%, OA 97.8%. The negative laparotomy rate in 1996 was 5.4% (appendix not inflamed by histological examination), perforation rate 11.5%. 25 wrong sonographic diagnoses were made. Out of 530 Patients examined 1995 and 1996 181 alternative diagnoses could be made by ultrasonography. Under not corresponding clinical and sonographic results patients were observed in hospital and clinical and sonographic examination were repeated within 6 hours. Under definite positive sonographic result and questional clinical result operation was preferred. Under recurrent attacks of abdominal pain diagnostic laparoscopy was recommended. Sonographic diagnosis of right sided abdominal pain helped to reduce the risk of restricted indication for diagnostic laparoscopy respectively appendectomy by reducing the number of unnecessary operations without relevant change of perforation rate.
1993年1月1日至1997年9月30日，由一位经验丰富的超声检查医师对1149例右侧腹痛患者进行了检查。急性阑尾炎超声诊断的特异性为98.7%，敏感性为95.6%，阳性预测值为96.5%，阴性预测值为98.3%，准确性为97.8%。1996年阴性剖腹手术率为5.4%（组织学检查显示阑尾未发炎），穿孔率为11.5%。超声检查出现了25例错误诊断。在1995年和1996年检查的530例患者中，超声检查做出了181例其他诊断。对于临床和超声检查结果不一致的患者，留院观察，并在6小时内重复进行临床和超声检查。对于超声检查结果明确为阳性而临床结果存疑的患者，优先进行手术。对于反复腹痛发作的患者，建议进行诊断性腹腔镜检查。右侧腹痛的超声诊断有助于降低诊断性腹腔镜检查或阑尾切除术指征受限的风险，通过减少不必要手术的数量，而穿孔率无相关变化。
