The role of CT in decision for acute appendicitis treatment.
The role of CT in decision for acute appendicitis treatment.
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DOI：
10.5152/dir.2022.201048
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发表时间：
2022-11
期刊：
影响因子：
--
通讯作者：
Tuney D
中科院分区：
文献类型：
--
作者：
Kus CC;Ilgın C;Yeğen C;Demirbas BT;Tuney D
急性阑尾炎是需要手术治疗的急腹症的最常见原因。尽管标准治疗是手术，但近年来发现可以通过抗生素和非手术观察进行治疗。在这项研究中，我们的目的是确定诊断为急性阑尾炎的患者的计算机断层扫描（CT）结果是否可以用于指导治疗。对2015年至2019年期间接受CT检查的138例急性阑尾炎患者进行回顾性分析。本研究对药物治疗组（n = 60例）与手术治疗组（n = 78例）以及抗生素治疗成功组（n = 23例）与抗生素治疗不成功组（n = 14例）进行比较。采用Pearson卡方检验和Mann-Whitney U检验比较各组阑尾壁厚度、阑尾直径、附壁增强的严重程度、腹腔内游离液体、阑尾周围脂肪绞合的严重程度、盲周淋巴结大小、阑尾结石、邻近器官表现以及CT阑尾炎评分。使用多变量逻辑回归来确定手术治疗的预测因素，以比值比 (OR) 表示，置信区间为 95%。阑尾直径、CT 阑尾炎评分和开发模型的诊断效果通过受试者工作特征曲线进行量化。阑尾直径 (P < .001)、邻近器官检查结果 (P = 0.041)、CT 阑尾炎评分 (P < .001)、阑尾周围脂肪绞合的严重程度 (P = .002)、阑尾结石 (P = .001) 和腹腔内游离液体 (P < .001) 在两组之间显示出统计学显着差异。药物和手术治疗组。根据Logistic回归检验，若患者阑尾直径≥13 mm（OR = 5.1，95% CI：1.58～16.50）、阑尾结石（OR = 4，95% CI：1.17～13.63）、腹腔内游离液体（OR = 3.04，95% CI： 1.28-7.20），外科医生应该首选手术治疗。 CT阑尾炎评分、阑尾直径和模型的曲线下面积分别为0.742（95% CI：0659-0824）、0.699（95% CI：0.613-0.786）和0.745（95% CI：0.671-0.819）。当比较成功和不成功的药物治疗组时，唯一显着的参数是壁增强的严重程度（P = .005）。 CT 检查结果可能对外科医生犹豫不决的无并发症急性阑尾炎患者有帮助。对于阑尾直径≥13mm、腹腔内游离液体、阑尾结石、CT阑尾炎评分高、附壁强化严重的病例，建议手术治疗。
Acute appendicitis is the most common cause of acute abdomen requiring surgery. Although the standard treatment has been surgery, it has been seen in recent years that treatment is possible with antibiotics and non-operative observation. In this study, our aim is to determine whether the computed tomography (CT) findings in patients diagnosed with acute appendicitis can be used for directing treatment. A retrospective analysis was conducted on 138 patients with acute appendicitis who underwent CT between 2015 and 2019. In this study, medical treatment group (n = 60) versus surgical treatment group (n = 78) and successful antibiotic treatment group (n = 23) versus unsuccessful antibiotic treatment group (n = 14) were compared. Appendiceal wall thickness, appendiceal diameter, the severity of mural enhancement, intra-abdominal free fluid, the severity of periappendiceal fat stranding, size of pericecal lymph node, appendicolith, adjacent organ findings, and the CT appendicitis score of groups were compared with Pearson Chi-square and Mann–Whitney U tests. Multivariable logistic regression was used to identify predictors of surgical treatment, expressed as odds ratios (ORs) with 95% CIs. Diagnostic efficacies of appendiceal diameter, the CT appendicitis score, and the developed model were quantified by receiver operating characteristic curves. Appendiceal diameter (P < .001), adjacent organ findings (P = 0.041), the CT appendicitis score (P < .001), the severity of periappendiceal fat stranding (P = .002), appendicolith (P = .001), and intra-abdominal free fluid (P < .001) showed statistically significant differences between the medical and surgical treatment groups. According to the logistic regression test, if the patients are with appendiceal diameter ≥13 mm (OR = 5.1, 95% CI: 1.58-16.50), appendicolith (OR = 4, 95% CI: 1.17-13.63), and intra-abdominal free fluid (OR = 3.04, 95% CI: 1.28-7.20), surgeons should prefer surgical treatment. The area under the curves for the CT appendicitis score, the appendiceal diameter, and the model were 0.742 (95% CI: 0659-0824), 0.699 (95% CI: 0.613-0.786), and 0.745 (95% CI: 0.671-0.819), respectively. As the successful and unsuccessful medical treatment groups were compared, the only significant parameter was the severity of mural enhancement (P = .005). CT findings may be helpful in patients with uncomplicated acute appendicitis whose treatment surgeons are indecisive about. We can recommend surgical treatment in cases with appendix diameter ≥13 mm, intra-abdominal free fluid, appendicolith, high CT appendicitis score, and severe mural enhancement.
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