摘要
目的 探讨成人急性复杂型阑尾炎的临床特征.方法 回顾性分析2003年1月至2012年12月手术切除的742例急性阑尾炎病例,根据术后病理结果分为急性单纯性阑尾炎组和急性复杂型阑尾炎组.比较2组患者的一般情况、临床表现、体检结果、实验室检查及影像学检查结果,寻找急性复杂型阑尾炎的临床规律.结果 本组患者中急性复杂型阑尾炎533例（71.8％）,病理类型包括急性化脓性阑尾炎306例,急性蜂窝织性阑尾炎57例,阑尾穿孔59例,急性坏疽性阑尾炎100例,阑尾穿孔伴脓肿形成6例,阑尾炎合并肿瘤5例.较之单纯性阑尾炎,成人急性复杂型阑尾炎入院时白细胞计数更高（t=-7.142,P=0.000）,体检发现腹肌紧张者较多（χ^2=10.646,P=0.000）,B超或CT提示阑尾内有粪石嵌顿（χ^2=16.759,P=0.000）、右下腹局部积液者较多（χ^2=13.531,P=0.000）.多因素Logistic回归分析表明,无阑尾炎病史（OR=0.593,95％CI：0.373～0.942）、白细胞计数高于20×10^9/L（OR =2.717,95％ CI：1.834 ～4.027）、腹肌紧张（OR=1.649,95％CI：1.047～2.597）、B超或CT发现阑尾内粪石嵌顿（OR=2.939,95％CI：1.607～5.377）及阑尾周围积液（OR=3.273,95％CI：1.424 ～7.525）是成人急性复杂型阑尾炎的主要危险因素（P＜0.05）.结论 白细胞计数显著增高、腹部体检触及肌紧张、影像学检查发现阑尾粪石或阑尾周围积液对鉴别成人急性单纯性和复杂型阑尾炎有较大意义.
Objective To find out the clinical and pathological characteristics in acute complicated appendicitis. Methods A retrospective clinical analysis was made on 742 cases of acute appendicitis from January 2003 to December 2012. All cases underwent appendectomy. Patients were allocated to the acute complicated appendicitis （ACA） group and the acute uncomplicated appendicitis group based on pathological reports. The X2 test was used to check for differences between proportions. Multivariate analysis was made through the Logistic regression. Results Of 742 patients, 533 were allocated to the ACA group, including acute suppurative appendicitis 306 patients, acute gangrenous appendicitis 100 patiets, appendicitis with perforation 59 patients, appendicitis with abscess formation 6 patients and appendicitis with tumor 5 patients. Statistical result shows that the patients of ACA group usually had higher toal WBC count, local or diffuse muscle guarding, intraluminal stercolith or periappendiceal fluid. Logistic regression also indicated that ACA were mathematically related to high level white blood cell count （ 〉 20 ×10^9/L, OR = 2. 717, 95% CI： 1. 834 - 4. 027, P 〈 0. 05 ）, local or diffuse muscle guarding （ OR = 1. 649, 95 % CI： 1. 047 - 2. 597, P 〈 0. 05 ）, intraluminal stercolith （ OR = 2. 939, 95 % CI： 1. 607 - 5. 377, P 〈 0. 05 ） and periappendiceal fluid （OR=3.273, 95%CI： 1.424-7.525, P〈0. 05）. Conclusions Patients with high level WBC count, local or diffuse muscle guarding, intraluminal stercolith or periappendiceal fluid are likely suffering from acute complicated appendicitis. Appendectomy must be considered as first-line therapy other than conservative antibiotic therapy under these situations.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2014年第5期338-341,共4页
Chinese Journal of Surgery
关键词
阑尾炎
阑尾切除术
因素分析
统计学
Appendicitis
Appendectomy
Factor analysis,statistical
