急性单纯性阑尾炎和急性复杂型阑尾炎的临床特点分析

Clinical characteristic analysis of acute simple appendicitis and acute complicated appendicitis

目的统计分析急性单纯性阑尾炎和急性复杂型阑尾炎的临床特点,寻求术前鉴别诊断的方法。方法所有患者术前都测体温、作腹盆腔彩超检查,然后做阑尾切除术,术后行病理检查确诊,比较观察急性单纯性阑尾炎和急性复杂型阑尾炎患者体温>39℃的发生率、腹肌紧张发生率、阑尾粪石嵌顿发生率、阑尾周围积液发生率和游离腹盆腔积液发生率。结果急性单纯性阑尾炎有92例,占24.3%,急性复杂型阑尾炎有287例,占75.7%,急性复杂型阑尾炎的比例明显高于急性单纯性阑尾炎,急性单纯性阑尾炎组体温>39℃的发生率、腹肌紧张发生率、阑尾粪石嵌顿发生率、阑尾周围积液发生率均显著低于急性复杂型阑尾组(P<0.05);两组的游离腹盆腔积液发生率比较,差异无统计学意义(P>0.05)。结论术前出现>39℃的发热和腹肌紧张,发现阑尾粪石嵌顿和(或)阑尾周围积液,那诊断急性复杂型阑尾炎的可能性大,出现游离腹盆腔积液不是鉴别急性单纯性阑尾炎和急性复杂型阑尾炎的一项指标。

Objective To statistically analyze the clinical characteristic of acute simple appendicitis and acute complicated appendicitis to seek for preoperative differential diagnosis method. Methods All participants were requested to take temperature before operation and color Doppler ultrasound examinations in abdominal and pelvic cavities.Appendicectomy was implemented and then pathological examinations for definite diagnosis after surgery.The incidence rate of body temperature〉 39℃,abdominal muscle tension,appendiceal fecalith incarceration,fluid around appendix,and free abdominal pelvic effusion in patients with acute simple appendicitis or acute complicated appendicitis were compared and observed. Results Acute simple appendicitis was in 92 cases accounting for 24.3%,and acute complicated appendicitis was in 287 cases for 75.7%,the proportion in the latter was much higher than that in the former,incidence rate of body temperature 〉39℃ in patients with acute simple appendicitis,abdominal muscle tension,appendiceal fecalith incarceration,fluid around appendix were all greatly lower than those in the acute complicated appendicitis group（P〈0.05）.There was no significant difference in the incidence rate of free abdominal pelvic effusion（P〉0.05）. Conclusion Symptoms like body temperature〉 39℃ and abdominal muscle tension before surgery,and appearance of appendiceal fecalith incarceration and（or） fluid around appendix are probably diagnosed as acute complicated appendicitis.Free abdominal pelvic effusion is not an index to identify acute simple appendicitis or acute complicated appendicitis.