Is preoperative distinction between complicated and uncomplicated acute appendicitis feasible without imaging?
Is preoperative distinction between complicated and uncomplicated acute appendicitis feasible without imaging?
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DOI：
10.1016/j.surg.2016.04.021
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发表时间：
2016-09-01
期刊：
影响因子：
3.8
通讯作者：
Salminen, Paulina
中科院分区：
文献类型：
--
作者：
Lietzen, Elina;Mallinen, Jari;Salminen, Paulina
背景资料。阑尾炎研究的主要目的之一是对复杂性和非复杂性急性阑尾炎进行鉴别诊断，以便为每个患者提供最佳的治疗方法。本研究的数据是在我们的无并发症急性阑尾炎的随机抗生素治疗试验(APPAC)中前瞻性收集的，该试验比较了手术和抗生素治疗无并发症急性阑尾炎(NCT01022567)。我们对705例急性阑尾炎患者进行了CT检查。将368例无并发症的急性阑尾炎患者与337例有并发症的急性阑尾炎患者进行比较，并对无并发症的急性阑尾炎合并阑尾石性阑尾炎(n=256)和无并发症的急性阑尾炎穿孔和/或脓肿(n=78)进行亚组分析。入院时记录年龄、性别、体温(摄氏度)、症状持续时间、白细胞计数(E9/L)和C反应蛋白(mg/L)。计算白细胞计数、C反应蛋白和体温的受试者工作特性曲线。CA2患者的C反应蛋白水平显著高于无并发症的急性阑尾炎患者(分别为122和47，P<0.01)，且症状持续时间长于无并发症的急性阑尾炎患者；81%的CA2患者和38%的无并发症的急性阑尾炎患者在入院前24小时出现症状(P>；.001)。在受试者操作特性分析中，C反应蛋白和温度只有与无并发症的急性阑尾炎和CA2(曲线下面积0.7)相比才有临床意义，但不能确定最佳的截断点。在临床决策中，无论是临床结果还是实验室标记物都不足以准确估计急性阑尾炎的严重程度或确定阑尾结石的存在。目前的结果强调了计算机断层扫描在复杂性和非复杂性急性阑尾炎的鉴别诊断中的作用。
Background. One of the main aims of appendicitis research is the differential diagnostics between complicated and uncomplicated acute appendicitis that enable provision of the optimal treatment for each patient.Methods. Data in the present study were collected prospectively in our randomized antibiotic treatment for uncomplicated acute appendicitis trial (APPAC) comparing surgery and antibiotic treatment for uncomplicated acute appendicitis (NCT01022567). We evaluated 705 patients who had acute appendicitis on computed tomography. Patients with uncomplicated acute appendicitis (n = 368) were compared with all complicated acute appendicitis patients (n = 337), and subgroup analyses were performed between uncomplicated acute appendicitis and an appendicolith appendicitis (CA1; n = 256) and uncomplicated acute appendicitis and perforation and/or abscess (CA2; n = 78). Age, sex, body temperature (degrees C), duration of symptoms, white blood cell count (E9/L), and C-reactive protein (mg/L) were recorded on admission. Receiver operating characteristic curves were calculated for white blood cell count, C-reactive protein, and temperature.Results. CA2 patients had significantly greater C-reactive protein levels (mean 122 and 47, respectively, P < .001) and longer duration of symptoms than uncomplicated acute appendicitis patients; 81 % of CA2 patients and 38% of uncomplicated acute appendicitis patients had symptoms >24 hours before admission (P < .001). In receiver operating characteristic analysis, C-reactive protein and temperature had clinically significant results only in comparison with uncomplicated acute appendicitis and CA2 (area under the curve >0.7), but no optimum cutoff points could be identified.Conclusion. In clinical decision making, neither clinical findings nor laboratory markers are reliable enough to estimate the severity of the acute appendicitis accurately or to determine the presence of an appendicolith. The current results emphasize the role of computed tomography in the differential diagnosis of complicated and uncomplicated acute appendicitis.