Groebli Y, Deruaz C, Merlini M, Tschantz P
Service de Chirurgie, Hôpital des Cadolles, Suisse.
Ann Chir. 1998;52(10):959-64.
One-third of all cases of abdominal pain and a quarter of cases of right iliac fossa pain urgently admitted to hospital leave hospital with no precise diagnosis. Based on a series of 400 patients hospitalised for right iliac fossa pain, comprising 107 cases with no identified aetiology, this prospective study was designed to assess the medium-term outcome of these patients, with or without surgical exploration. 67 cases were reviewed at five years. No major diagnosis was missed. Over this 5-year period, 30 patients (45%) experienced another episode of abdominal pain. Among the third of patients (21 cases, 31%) reviewed for another episode of right iliac fossa pain, 7 were readmitted to hospital, with 5 operations, for histologically confirmed acute appendicitis in 3 cases (5% of the series). The patient and his attending physician must be informed of the nonspecific diagnosis established during the first hospitalisation. There is no significant evidence to suggest a psychological component in the recurrent nature of the pain. Cancer must be formally excluded in patients over the age of 50. When surgical exploration is performed, nowadays by laparoscopy, appendicectomy is recommended. This procedure does not decrease the risk of recurrent pain, but confirms the real absence of histopathological abnormality and decreases the number of subsequent hospitalisations.
因腹痛紧急入院的患者中有三分之一，因右下腹疼痛紧急入院的患者中有四分之一，出院时未得到确切诊断。基于一系列400例因右下腹疼痛住院的患者（其中107例病因不明），本前瞻性研究旨在评估这些患者无论是否接受手术探查的中期结局。对67例患者进行了为期五年的随访。没有漏诊重大疾病。在这5年期间，30例患者（45%）再次出现腹痛。在因再次出现右下腹疼痛而接受随访的三分之一患者（21例，31%）中，7例再次入院，其中5例接受了手术，3例经组织学确诊为急性阑尾炎（占该系列病例的5%）。必须告知患者及其主治医生首次住院期间所确定的非特异性诊断。没有显著证据表明疼痛复发具有心理因素。50岁以上的患者必须正式排除癌症。如今通过腹腔镜进行手术探查时，建议行阑尾切除术。该手术不会降低疼痛复发的风险，但能确认确实不存在组织病理学异常，并减少后续住院次数。
