Appendiceal faecaliths are associated with right iliac fossa pain
Appendiceal faecaliths are associated with right iliac fossa pain
复制标题
DOI：
10.1308/003588410x12518836439524
复制
发表时间：
2010-01-01
影响因子：
1.4
通讯作者：
Harris, Adrian
中科院分区：
文献类型：
--
作者：
Grimes, Caris;Chin, Diana;Harris, Adrian
引言 对于在诊断性腹腔镜检查中是否应该切除看起来正常的阑尾以治疗右髂窝 (RIF) 疼痛，存在争议。粪石与阑尾炎有关。本研究评估了切除含有粪石的正常阑尾与症状改善之间是否存在关联。患者和方法对 2003 年至 2007 年期间所有组织学正常的阑尾切除术的组织学数据库进行分析，注意到粪石的存在。使用电话问卷进行回顾性研究，了解术前症状的频率/持续时间、术后症状复发、再入院率和并发症。将粪石阳性 (f(+)) 组与切除正常阑尾但不含粪石 (f(-)) 的类似对照组患者进行比较。 结果 在 203 例组织学正常的阑尾切除术中，26 例 (13%) 为 f(+)。其中，21 人回复了调查问卷。连续 31 名患者组织学正常且无粪石。每组中在阑尾切除术前出现 3 次或以上疼痛的比例相似（38% f(+)；39% 对照）。 f(+) 患者中只有 1 名（5%）术后症状复发，而对照组有 14 名（48%）出现症状（P = 0.0016）。只有 1 名 f(+) 患者 (5%) 接受了进一步检查，而对照组有 11 名 (36%) 患者接受了进一步检查 (P < 0.02)。没有 f(+) 患者再次入院，而对照人群中这一比例为 19%。两组均未出现明显的术后并发症。结论在无明显阑尾炎症的情况下，阑尾粪石可能是右髂窝疼痛的原因。在这项研究中，在没有任何其他明显病理的情况下，在腹腔镜检查中常规切除看起来正常的阑尾的政策似乎是治疗粪石病例复发症状的有效方法。需要进一步的研究来评估这种假定的关联。
INTRODUCTION There is debate over whether a normal-looking appendix should be removed at diagnostic laparoscopy performed for right iliac fossa (RIF) pain. Faecaliths are associated with appendicitis. This study assessed whether there was an association between the removal of normal appendices containing faecaliths and improvement of symptoms.PATIENTS AND METHODS Analysis of the histology database for all appendicectomies during 2003-2007 with normal histology, noting presence of a faecalith. Retrospective study using a telephone questionnaire for frequency/duration of pre-operative symptoms, postoperative symptom recurrence, re-admission rates and complications. The faecalith-positive (f(+)) group was compared to a similar control group of patients who had a normal appendix removed which did not contain a faecalith (f(-)).RESULTS Out of 203 appendicectomies performed with normal histology, 26 (13%) were f(+). Of these, 21 responded to the questionnaire. Thirty-one consecutive patients with normal histology and no faecalith were identified. A similar proportion in each group presented with three or more episodes of pain prior to appendicectomy (38% f(+); 39% control). Only one (5%) of the f(+) patients had recurring symptoms after the operation, compared with 14 (48%) of the control group (P = 0.0016). Only one (5%) of the f(+) patients underwent further investigations, compared with 11 (36%) of the control group (P < 0.02). None of the f(+) patients were re-admitted, compared to 19% of the control population. There were no significant postoperative complications in either group.CONCLUSIONS Appendiceal faecaliths may be a cause of right iliac fossa pain in the absence of obvious appendiceal inflammation. In this study, the policy of routine removal of a normal-looking appendix at laparoscopy in the absence of any other obvious pathology appeared to be an effective treatment for recurrent symptoms in those cases with a faecalith. Further studies are needed to assess this putative association.