[Diagnosis of appendicitis with particular consideration of the acupuncture point Lanwei--a prospective study].
[Diagnosis of appendicitis with particular consideration of the acupuncture point Lanwei--a prospective study].
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DOI：
10.1159/000069233
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发表时间：
2002-12
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影响因子：
--
通讯作者：
S. Alt-Epping;T. Ostermann;J. Schmidt;H. Zirngibl
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文献类型：
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作者：
S. Alt-Epping;T. Ostermann;J. Schmidt;H. Zirngibl
背景在几乎所有的西方工业国家，阑尾炎是最常见的原因急腹症。然而，阑尾炎的诊断往往是困难的，这表现在高度阴性剖腹手术率。在一项前瞻性研究中，我们的目的是调查是否触诊位于右腿的穴位兰卫（额外的点22，额外的点33）可能会增加阑尾炎诊断的准确性。病人和方法：术前，对116名因怀疑阑尾炎入院的合作非麻醉病人进行兰卫穴可重复压痛检查。并与组织学诊断结果进行比较。在不了解其他检查结果的情况下，进行了兰卫征压痛检查。此外，使用标准化的记录表格检查阑尾炎的其他体征和实验室参数。总共评价了17个术前变量、18个临床体征和3项试验。结果兰卫征阳性65例（56%），兰卫征阴性51例（44%）。116例患者中65例接受了手术治疗。其中59人有组织学证实的阑尾炎。兰卫征诊断乳腺癌的敏感性为64.4%，特异性为50%。阳性和阴性预测值的比率分别为92.7%和12.5%。比值比估计为1.8。当比较这些参数时，兰威征在阑尾炎的22个最重要的临床体征中位于第7位和第10位之间。阴性开腹率为9%，其中4/6例有其他手术指征。穿孔率为15%。结论与Mc Burney征、谢伦三角区压痛、阑尾缩小等阑尾炎常规征象相比，兰威征的诊断价值不足。虽然可重复的阳性兰卫征是真正阑尾炎的良好提示，但在阴性兰卫征的情况下，阑尾炎的概率可能相对较高。由于阴性预测值较低，兰威征不适合用于降低腹腔镜手术的阴性率。与许多其他研究一样，在本研究中未检测到阑尾炎的唯一指标，该指标在所有统计参数中均产生高结果。与传统阑尾炎体征的统计学参数相比，兰卫征不能作为阑尾炎的良好诊断参数。
BACKGROUND In almost all Western industrial nations, appendicitis is the most frequent cause for acute abdomen. Nevertheless, the diagnosis of appendicitis is often difficult, which manifests in highly negative laparotomy rates. In a prospective study we aimed to investigate if palpation of the acupuncture point Lanwei (extra point 22, extra point 33) which is located on the right leg may increase the accuracy in the diagnosis of appendicitis. PATIENTS AND METHODS Presurgically, the Lanwei point was examined for reproducible tenderness on 116 cooperative nonanesthetized patients admitted to hospital for suspected appendicitis. The results were compared with those of histological diagnosis. The examination of tenderness of the Lanwei sign was performed without knowing the results of other examinations. Additionally, other signs and laboratory parameters for appendicitis were examined using a standardized documentation form. Altogether, 17 presurgical variables, 18 clinical signs, and 3 tests were evaluated. RESULTS A positive Lanwei sign was documented in 65 cases (56%), whereas 51 patients (44%) had a negative Lanwei sign. 65 of the 116 patients were operated. 59 of those had a histologically proven appendicitis. The sensitivity of the Lanwei sign was 64.4%, specificity ranged at 50%. Rates for positive and negative predictive values were 92.7% and 12.5%, respectively. Odds ratio was estimated as 1.8. When comparing these parameters, the Lanwei sign ranged between the 7th and 10th place of the 22 most important clinical signs for appendicitis. The negative laparotomy rate was 9%, of which 4 of 6 patients had other indications for an operation. The rate of perforation was 15%. CONCLUSION Compared with many conventional signs for appendicitis as for example Mc Burney, tender Sherren triangle, reduced peristalsis, the diagnostic value of the Lanwei sign is not sufficient. Although a reproducible positive Lanwei sign is a good hint for a true appendicitis, in case of a negative Lanwei sign the probability for an appendicitis may be relatively high. Because of the low negative predictive value, the Lanwei sign is not suitable for reducing negative laparatomy rates. As in many other studies, the one and only indicator for appendicitis which yields high results in all statistical parameters was not detected in this study. In comparison to the statistical parameters of traditional signs for appendicitis, the Lanwei sign cannot be regarded as a good diagnostic parameter for appendicitis.