- 期刊
Negative Appendectomy Can be Minimized with Physical Tests by an Experienced Abdominal Surgeon: A Preliminary Report
有經驗的消化外科醫師可降低陰性闌尾切除率：初期報告
摘要
背景：急性闌尾炎行闌尾切除手術，是台灣目前最常見的急診手術。然而文獻上，陰性闌尾切除率，仍有15%左右。在台灣健保Case Payment的給付下，善用有限醫療資源理念下，對於臨床醫師、尤其是外科醫師，強調理學檢查之重要性。 方法：同一位外科主治醫師於連續半年內，在其值班時，由急診醫師診斷為急性闌尾炎而會診本人的病例為研究對象。有42位病人，經仔細的理學檢查，例行性血液、尿液及胸腹X光檢驗，作為手術與否之主要依據。 結果：42病人中，有34人行闌尾切除手術。其中男性20人、女性14人，平均年齡33歲。19位(55.9%)屬單純性(simple)急性闌尾炎，15位(44.1%)屬複雜性(complicated)急性闌尾炎。平均住院日數為4.7日。一位病人傷口感染(2.9%)。這34位闌尾切除病人，其病理化驗全為急性闌尾炎，故本研究達到全部正確的闌尾切除率。其餘8位未接受闌尾切除手術病人，於住院數日後分別於不同診斷下出院，並追蹤貳個月，未有因急性闌尾炎接受治療。 結論：一位有經驗的消化外科專科醫師，可以降低陰性闌尾切除率。在目前台灣健保case Payment的給付下，手術前仔細的理學檢查是診斷急性闌尾炎有效且經濟的方法。
並列摘要
Background: Because of limited reimbursement for appendectomy by the national health insurance system in Taiwan, we designed a study to evaluate whether eliminating expensive presurgical tests might lead to more economical treatment of patients with acute appendicitis. Material and Methods: A prospective study was performed with 42 patients with suspected appendicitis over a period of 6 months. Forty-two patients (mean age: 33 years) with suspected acute appendicitis were consecutively admitted to the same duty surgeon's service. Each patient underwent a thorough physical examination, a series of laboratory tests, and chest and abdominal x-ray studies. Results: Among these 42 patients, 34 (20 males, 14 females) with persistent local right-quadrant tenderness were treated with appendectomies. The mean age was 33 years old. Nineteen patients (55.9%) had uncomplicated appendicitis, and 15 (44.1%) had complicated appendicitis. Acute appendicitis was accurately diagnosed in all the patients who had received appendectomy in this study. The mean hospital stay was 4.7 days. One patient developed infection at the surgical site (2.9%). No patient had a negative, or unnecessary, appendectomy, and 8 other patients were discharged without operation after diagnostic studies. Conclusions: The incidence of negative appendectomy can be minimized by careful physical examination by an experienced abdominal surgeon. Such examinations are also an effective and economic method for diagnosing acute appendicitis.
延伸閱讀
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