阑尾粪石与急性阑尾炎关系的分析

Analysis of fecalith associated with acute appendicitis

目的:分析阑尾粪石与急性阑尾炎的关系。方法 :回顾分析2010年1月至2014年12月所有怀疑急性阑尾炎接受手术治疗的病人。收集相关数据包括阑尾病理类型、阑尾是否存在粪石等。根据CT和超声检查诊断阑尾粪石,分为粪石组与非粪石组作研究。比较两组的术前诊断准确率,分析粪石与穿孔性阑尾炎或坏疽性阑尾炎的关系,以及粪石部位与穿孔性阑尾炎或坏疽性阑尾炎的关系。结果:5 538例纳入本研究,病理检查明确急性阑尾炎5 386例。阑尾粪石病人共1 647例(29.7%)。粪石组术前诊断急性阑尾炎准确率高于非粪石组(98.1%比96.9%,P<0.05)。其中阑尾粪石组急性阑尾炎病人易发生阑尾坏疽/穿孔(18.5%比9.9%,P<0.001),尤其是粪石位于阑尾根部的病人(27.7%比15.4%,P<0.001)。结论:合并阑尾粪石的急性阑尾炎病人易坏疽/穿孔,尤其是粪石位于阑尾根部者。

Objective To analyze the association between the presence of fecalith and acute appendicitis. Methods Data of the patients who underwent surgical treatment of acute appendicitis between Jan 2010 and Dec 2014 were collected including the pathological types, and the fecalith diagnosed by CT scan and uhrasonography. The patients were divided into fecalith group and non fecalith group. The accurancy of preoperative diagnosis between two group was compared. The association between fecalith and gangrenous/perforated appendicitis and between the location of fecalith and gangrene/per- foration appendicitis was analyzed. Results There were 5 538 cases in this study including 5 386 cased with acute appendicitis diagnosed by pathology. There were 1 647 cases （29.7%） with fecalith. The accuracy of preoperative diagnosis as acute appendicitis was higher in fecalith group than in non fecalith group （98.1% vs 96.9%, P〈0.05）. The cases with acute appendicitis developed to gangrenous/perforated more in fecalith group than in non fecalith group （18.5% vs 9.9%, P〈0.001）. The cases with fecalith in the proximal region of appendix had gangrenous/perforated more than the other region （27.7% vs 15,4%, P〈0.001）. Conclusions Acute appendicitis with fecalith would be associated with gangrenous/perfora- ted, especially fecalith in the proximal region of appendix.