Predictors of Perforated Acute Appendicitis: A Retrospective Study from a Single Institution

穿孔性急性闌尾炎的預測因子：一個單一機構的回顧性研究

周家麟(Chia-Lin Chou) ； 翁世峰(Shih-Feng Weng) ； 鄭立勤(Li-Chin Cheng) ； 田宇峯(Yu-Feng Tian) ； 曾建仁(Chien-Jen Tseng)

《中華民國大腸直腸外科醫學會雜誌》 25卷2期 (2014/06) Pp. 27-35

https://doi.org/10.6312/SCRSTW.2014.25(2).10302

摘要

目的　因為急性闌尾炎的病程進展及後續術後併發症的風險，使得闌尾切除術一直是治療急性闌尾炎的標準。本研究的目的是找出複雜性急性闌尾炎的獨立預測因子。方法　本研究回溯性蒐集在奇美醫學中心診斷為急性闌尾炎的病人資料。在2010年1月到12月間，480名病人因急性闌尾炎接受闌尾切除手術。在兩組－非穿孔性案例（n = 332）和穿孔性案例（n = 92）－進行分析，比較臨床特徵，住院時間和術後併發症。結果　92例穿孔性闌尾炎和332例單純性闌尾炎均經病理證實。整體闌尾炎穿孔率為21.70%（92/424），陰性闌尾切除率分別為11.67%（56/480）。單變異和多變異回歸分析發現與穿孔性闌尾相關的兩個獨立因子；腹痛超過3天（勝算比：3.03，95%信賴區間1.62-5.65，p ＜ 0.001）和C-反應蛋白值超過30毫克／公升（勝算比：5.38，95%信賴區間：2.52-11.50，p ＜ 0.001）。結論　腹部電腦斷層掃描被證明可以非常準確的診斷闌尾炎，但對於穿孔性闌尾炎的特異性評估仍沒有結論。高C-反應蛋白值及病人延遲就醫這兩項因素，是複雜闌尾炎的獨立預測因子。

關鍵字

穿孔性急性闌尾炎 ； C-反應蛋白 ； 腹部電腦斷層

並列摘要

Purpose. Prompt appendectomy has long been the standard of treatment for acute appendicitis, due to the risk of progression and subsequent postoperative complications. This study aimed to identify independent predictors of acute complicated appendicitis. Methods. Data were obtained from a retrospective database that recorded all appendicitis cases at the Chi-Mei Medical Center Data. There were 480 consecutive patients undergoing appendectomy for suspected acute appendicitis between January and December 2010. Two patient groups, without perforation (N = 332) and with perforation (N = 92), were analyzed to compare clinical characteristics, hospital stay, and post-operative complications. Results. Ninety-two patients with appendiceal perforation and 332 patients with simple appendicitis were confirmed pathologically. The overall perforation rate of appendicitis was 21.70% (92/424), and the negative appendectomy rate was 11.67% (56/480). Univariate and multivariate logistic regression analysis identified 2 independent factors associated with appendiceal perforation, the duration of abdominal pain for over 3 days (odds ratio (OR): 3.03, 95% confidence interval (CI): 1.62-5.65, p ＜ 0.001) and a C-reactive protein level over 30 mg/dl (OR: 5.38, 95% CI: 2.52-11.50, p ＜ 0.001). Conclusions. Computed tomography (CT) scanning has been shown to be highly accurate for diagnosing appendicitis, but it has not been specifically evaluated for perforated appendicitis. Combining the results of higher C-reactive protein levels obtained in the emergency department and patient delay are the predominant factors determining the incidence of complicated appendicitis.

並列關鍵字

Perforated acute appendicitis ； C-reactive protein ； Abdominal computed tomography