Value of Preoperative Physical Examination in Diagnosing Acute Appendicitis

術前理學檢查診斷急性闌尾炎之價值

游伯齡(Po-Ling Yu)

《北市醫學雜誌》 3卷12期 (2006/12) Pp. 69-74

https://doi.org/10.6200/TCMJ.2006.3.12.08

摘要

目的：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85%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。而以發病至醫院求診這段時間(patient's delay)作為比較，複雜性闌尾炎比單純性闌尾炎較長久(41.5 hours vs. 22.5 hours, p＜0.05)。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，故本研究陰性闌尾切除率為零。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，並追蹤壹個月，未有因急性闌尾炎接受治療。結論：對於一位有經驗的外科醫師，陰性闌尾切除是可以避免的。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。

關鍵字

病人延誤 ； 陰性闌尾切除

並列摘要

Background and Purpose: To justify the detail preoperative physical examination is effective and economic method in diagnosing acute appendicitis under the Payment System of National Health Insurance in Taiwan. Methods: During the past 6-month period, a prospective study was done. Forty-two suspected acute appendicitis patients (age from 8 to 88 years old) were consecutively admitted under the same duty surgeon's service. Routine laboratory examinations and chest plus abdominal x rays were essentially performed in each patient. Results: All thirty-four patients with persistent local tenderness received appendectomy (male 20, female 14). The mean age was 33 years old. Nineteen patients (55.9%) had simple appendicitis; fifteen patients (44.1%) had complicated appendicitis. Patient's delay (onset to hospital) is significantly longer in complicated appendicitis compared to patients with simple appendicitis (41.5 hours vs. 22.5 hours, p＜0.05). The mean hospital stay was 4.7 days. One patient had wound infection (2.9%). None negative appendectomy was done in this study. The other eight patients were discharged without operation after essential investigations. Conclusion: Negative appendectomy can be avoided by an experienced surgeon. Physical examination is effective and economic method in diagnosing acute appendicitis under the payment system of National Health Insurance in Taiwan.

並列關鍵字

patient's delay ； negative appendectomy