应用经脐单孔腹腔镜探查对ALVARADO评分系统诊断急性阑尾炎的再评估

Re-evaluation of Alvarado score in diagnosis of acute appendicitis using transumbilical single-port laparoscopic exploration

目的:通过经脐单孔腹腔镜探查,再进行评估ALVARADO评分系统在急腹症诊疗中的价值.方法:对210例急腹症患者应用ALVARADO评分系统评估后进行经脐单孔腹腔镜探查术,根据探查结果与ALVARADO评分系统对应分析,术后追踪随访1年.结果:101例ALVARADO评分9分以上,只有2例为非阑尾炎急腹症,准确率为98.1%,85例评分7-8分,74例为阑尾炎,准确率为87.1%;24例5-6分加阳性的超声或CT结果的患者,23例为急性阑尾炎,诊断准确率为95.8%.结论:ALVARADO评分系统对于急性阑尾炎的诊断有一定参考价值.但7分以下仍然有一定的假阳性率.应结合超声和CT检查进一步提高准确性和特异性;对急腹症患者应用经脐单孔腹腔镜技术早期探查,可减少诊断和治疗的延误,对于非阑尾炎急腹症不影响后续的外科治疗,安全可行.

AIM： To re-evaluate the Alvarado score in the diagnosis of acute appendicitis using transum- bilical single-port laparoscopic exploration. METHODS： Clinical data for 210 patients with acute appendicitis who underwent transumbili- cal single-port laparoscopic exploration and A1- varado scoring were retrospectively reviewed. The correlation between Alvarado score and operative outcome was analyzed. RESULTS： 101 had an Alvarado score above 9,of whom appendicitis was excluded by explora- tion in only 2 cases, and the diagnostic accuracy of Alvarado score was 98.1% in these patients. 85 patients had an Alvarado score between 7 and 8, of whom 74 were confirmed to have acute appendicitis by exploration, and the diagnostic accuracy of Alvarado score was 87.1% in these patients. Of 24 patients who had a positive CT or ultrasound finding and an Alvarado score be- tween 5 and 6, 23 were confirmed to have acute appendicitis, and the diagnostic accuracy of Alvarado score was 95.8% in these patients. No port-site hernia or constipation was found dur- ing a follow-up period of I year. CONCLUSION： Alvarado score is useful in the diagnosis of acute appendicitis, especially when the score is above 9. When the score is between 7 and 8, there is a false positive rate as high as 13% if the Alvarado system is used alone. Alvarado scoring combined with imaging examination is associated with a higher accuracy in the diagno- sis of acute appendicitis.