Acute appendicitis and the role of pre-operative imaging: A cohort study.
Acute appendicitis and the role of pre-operative imaging: A cohort study.
复制标题
DOI：
10.1016/j.amsu.2020.10.008
复制
发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Andrews B
中科院分区：
文献类型：
--
作者：
Rait JS;Ajzajian J;McGillicuddy J;Sharma A;Andrews B
急性右髂窝(RIF)疼痛是外科手术团队最常见的表现之一。急性阑尾炎是引起这种疼痛的最常见原因，通常需要手术治疗。在许多情况下，介入会导致阴性的阑尾切除，并因此产生不必要的并发症。本研究的目的是比较术前影像诊断急性阑尾炎的效果，以减少阴性阑尾切除术和不必要的手术干预的发生率。在一家地区综合医院(DGH)进行了一项为期六年的回顾性单中心队列研究，研究对象是所有的腹腔镜阑尾切除术。1344例患者接受了术前影像检查(和分型)或不做检查。在组织学分析的基础上，分析每种影像诊断阑尾炎的敏感性、特异性、阴性预测值和阳性预测值。超声检查阴性率最高(48.21%)，CT检查阴性率(20.26%)低于单纯临床诊断者(20.73%)。USS对急性阑尾炎的诊断敏感性低于CT。临床诊断与CT诊断阴性阑尾切除率差异无统计学意义。术前影像在阑尾炎的诊断中有一定作用，但需要适当地利用，以减少外科部门的压力，防止阴性阑尾切除术的可能性。术前影像对急性阑尾炎的诊断有一定作用，应慎重选择合适的影像检查方式，以维持较低的阴性率。在某些急性阑尾炎病例中，单凭临床诊断可能就足够了。
Acute right iliac fossa (RIF) pain is amongst the most common presentation to the surgical team. Acute appendicitis is the most common cause of this pain and often warrants surgical intervention. In many cases intervention results in a negative appendicectomy with unnecessary complications as a result. The aim of this study was to compare the efficacy of pre-operative imaging in the diagnosis of acute appendicitis to reduce the rate of negative appendicectomy and unnecessary operative intervention. A retrospective single centre cohort study was undertaken in a district general hospital (DGH) of all laparoscopic appendicectomies over a six-year period. 1344 cases were included and were examined for the use of pre-operative imaging (and type) or none. The sensitivity, specificity, negative and positive predictive value for each type of imaging were analysed for their accuracy in diagnosis appendicitis based on the final histological analysis. The negative appendicectomy rate was found to be greatest in those undergoing ultrasonography (48.21%) as their method of pre-operative imaging whilst those who underwent computed tomography (CTAP 20.26%) had a lower rate equivalent to that of clinical diagnosis alone (20.73%). USS is less sensitive than CT in diagnosing acute appendicitis. There is no statistically significant difference in negative appendicectomy rate between clinical diagnosis and CT diagnosis. Pre-operative imaging has a role in the diagnosis of appendicitis but needs to be utilised appropriately to reduce the strain on the surgical department and prevent the potential of a negative appendicectomy. Pre-operative imaging has a role in the diagnosis of acute appendicitis The selection of the appropriate modality of imaging should be carefully selected to maintain a low negative appendicectomy rate Clinical diagnosis alone may be sufficient in certain cases of acute appendicitis
登录
查看更多内容
影响因子：
9.6
作者：
Nepogodiev, D.;Matthews, J. H.;Bhangu, A.
通讯作者：
Bhangu, A.
影响因子：
9.6
作者：
Bhangu, A.;Richardson, C.;Pinkney, T.
通讯作者：
Pinkney, T.
影响因子：
9
作者：
Fleming, Fergal J.;Kim, Michael J.;Monson, John R.
通讯作者：
Monson, John R.
影响因子：
--
作者：
Smith-Bindman R;Lipson J;Marcus R;Kim KP;Mahesh M;Gould R;Berrington de González A;Miglioretti DL
通讯作者：
Miglioretti DL
DOI：
10.1308/003588410x12518836439524
发表时间：
2010-01-01
影响因子：
1.4
作者：
Grimes, Caris;Chin, Diana;Harris, Adrian
通讯作者：
Harris, Adrian