急性阑尾炎915例诊治分析

Diagnosis and Treatment of 915 Cases of Acute Appendicitis

目的:探讨急性阑尾炎的术前诊断,术中诊断及治疗方法。方法:采用回顾性分析临床资料,915例2007年1月至2013年12月本院入院前诊断急性阑尾炎患者,比较术前诊断是否行下腹部CT检查;比较术中不同类型阑尾炎患者平均就诊时间,平均就诊时血常规白细胞计数变化,术中肉眼所见与术后病理是否一致,术后是否有并发症等。结果:部分不同类型阑尾炎患者平均就诊时间,平均就诊时血常规白细胞计数变化,有无并发症等有显著差异改变(P<0.05),肉眼所见与术后病理有差别,但无统计学差异(P>0.05);术前确诊是否需CT检查无统计学差异(P>0.05)。结论:非典型阑尾炎术前诊断不易,最好行下腹部CT检查;不同类型阑尾炎之间白细胞计数有价值;如急性阑尾炎诊断明确,建议早期手术治疗;保守治疗适合于大部分阑尾包块,及下腹部CT提示无粪石嵌顿,或渗出不明显的患者。

Objective： To explore the preoperative diagnosis,intraoperative diagnosis and treatment methods of acute appendicitis. Methods：915 cases which was diagnosed of acute appendicitis before operation from January,2007 to December,2013 were retrospective analyzed,if there had CT examination,the average visiting time,the average counts of white blood cells（WBC） and postoperative complications were compared; also the intraoperative macroscopic findings were compared with postoperative pathology.Results：There have remarkable significance on the the average visiting time,the average counts of WBC and postoperative complications in partial different type of patient with appendicitis（P 〈 0.05）,there have no remarkable significance on the CT examination,intraoperative macroscopic findings and postoperative pathology（P 〉 0.05）.Conclusion：Preoperative diagnosis is difficult on the atypical appendicitis,we recommend lower abdominal CT scan; the counts of WBC in different type of appendicitis has a value ; if there had clear diagnosis of acute appendicitis,we suggested early operation,the conservative therapies are suitable for majority of patients with appendix mass and the CT scan showed no stercoral incarceration or no obvious exudation.