急性阑尾炎非手术治疗致脓肿形成的风险因素分析

Analysis on risk factors affecting abscess formation caused by non-operative treatment for acute appendicitis

目的分析急性阑尾炎非手术治疗后脓肿形成的风险因素。方法回顾性分析急诊外科非手术消炎治疗的急性阑尾炎患者170例,按消炎治疗后是否形成脓肿分为A组(形成脓肿)与B组(无脓肿),比较两组性别、年龄、发病时间、有无腹膜炎、治疗前的体温(T)、白细胞(WBC)、中性粒细胞百分比、C反应蛋白(CRP)、影像学检查是否有阑尾粪石或腹腔渗液、阑尾直径(以7.95 mm为分界标准)、消炎治疗时间的差异,分析脓肿形成的影响因素。结果 A组41例,B组129例。单因素分析发现,与B组比较,A组发病时间长、腹膜炎多、治疗前的体温高、WBC高、中性粒细胞百分比高、CRP高、腹腔渗液多、阑尾直径粗、消炎治疗时间长(P <0.05);多因素Logistic回归分析显示,腹膜炎(OR=5.875,95%CI 1.704~20.251)、中性粒细胞百分比≥85%(OR=6.384,95%CI 1.949~20.905)、腹腔渗液(OR=23.074,95%CI 6.868~77.520)为脓肿形成的独立风险因素。结论急性阑尾炎患者若并发腹膜炎、中性粒细胞百分比≥85%、腹腔渗液3项临床表现之一时,非手术治疗易形成脓肿,建议考虑手术治疗。

Objective To analyze the risk factors affecting abscess formation caused by non-operative treatment for acute appendicitis.Methods A total of 170 patients with acute appendicitis who have received non-operative treatment in the Department of Emergency Surgery were retrospectively analyzed and divided into Group A(abscess formed)and Group B(free of abscess)according to the presence of abscess after anti-inflammation treatment.Comparison was made between the two groups in terms of gender,age,onset time,presence of peritonitis,body temperature(T),white blood cell(WBC),percentage of neutrophilic granulocyte,and C-reactive protein(CRP)before the treatment,presence of appendiceal fecalith or peritoneal exudate and diameter of appendix(cut-off value:7.95 mm)shown in imaging examination,and time of anti-inflammation therapy,so as to analyze the factors affecting abscess formation.Results The univariate analysis showed that compared to Group B(n=129),Group A(n=141)had longer time of onset,more cases of peritonitis,higher body temperature,higher WBC,higher percentage of neutrophilic granulocyte,higher CRP,larger amount of peritoneal exudate and larger diameter of appendix and longer time of anti-inflammation therapy(P<0.05);multivariate logistic regression analysis showed that peritonitis(OR 5.875,95%CI 1.704-20.251),percentage of neutrophilic granulocyte≥85%(OR=6.384,95%CI 1.949-20.905)and peritoneal exudate(OR=23.074,95%CI 6.868-77.520)constituted the independent risk factors of abscess formation.Conclusion It is recommended to perform operative treatment for patients with acute appendicitis accompanied by one of the three clinical manifestations(i.e.,peritonitis,percentage of neutrophilic granulocyte≥85%,and peritoneal exudate),as non-operative treatment is prone to cause abscess formation.