急性阑尾炎穿孔因素及手术时机的选择

Factors of acute appendicitis perforation and the choice of operation time

目的探讨急性阑尾炎穿孔因素及手术时机的选择。方法选取2012年1月~2015年1月537例行阑尾切除术的患者资料,分为穿孔组及未穿孔组,统计分析两组患者性别、年龄、BMI、Charlson合并症指数、中性粒细胞及淋巴细胞计数、CT阑尾横径、院前延误时间、术前时间等。结果穿孔率为23.1%。穿孔组平均年龄、合并症指数、CT阑尾横径及院前延误时间大于未穿孔组（P〈0.05）,而淋巴细胞计数低于未穿孔组。两组患者的性别、BMI、体温、中性粒细胞计数及术前时间无明显差异（P〉0.05）。高龄、合并症指数的增高、淋巴细胞计数降低、阑尾横径的增加及院前延误均是穿孔发生的危险因素。结论应结合患者年龄、合并症、阑尾横径及院前延误判断病情,选择最佳手术时机,减少不良事件的发生。

Objective To explore the factors of acute appendicitis perforation and the choice of operation time. Methods The data of 537 patients underwent appendectomy between January 2013 and January 2015 were selected and divided into perforation group and no perforation group.The age,gender,BMI,Charlson index,NC,TLC,appendiceal diameter measured by CT,out-of-hospital delay and time-to-incision in two groups,were analyzed statistically. Results Perforation rate was 23.1%.The age,Charlson index,appendiceal diameter and out-of-hospital delay of perforation group were higher or longer than unperforation group（P〈0.05）,and TLC of perforation was lower than that of unperforation group（P〈0.05）.There are no difference in gender,BMI,temperature,NC and time-to-incision between tow groups.Advanced age,high Charlson index score,lower TLC,increased diameter and out-of-hospital delay were risk factors of appendiceal perforation. Conclusion Age,comorbidity,appendiceal diameter and out-of-hospital delay should be considerated for choose the optimal time to appendectomy.