阑尾结石及其特征对急性阑尾炎严重程度的影响。

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-09-03 DOI:10.1093/bjsopen/zrae093
Sami Sula, Timo Paananen, Ville Tammilehto, Saija Hurme, Anne Mattila, Tuomo Rantanen, Tero Rautio, Tarja Pinta, Suvi Sippola, Jussi M Haijanen, Paulina Salminen
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引用次数: 0

摘要

背景:据报道,对于未使用计算机断层扫描(CT)诊断出阑尾结石的无并发症急性阑尾炎,抗生素是一种高效、安全的治疗方案。本研究旨在评估 CT 诊断阑尾结石及其特征与阑尾炎严重程度的关系:对 2017 年 4 月至 2018 年 11 月间入组的疑似急性阑尾炎的大型前瞻性患者队列进行了回顾性回顾。初步分析评估了 CT 诊断阑尾结石与复杂性急性阑尾炎的相关性;然后,根据 CT 图像的可用性,分析了一部分患者阑尾结石特征与阑尾炎严重程度的相关性。所有患者的阑尾炎最终评估结果(无并发症或并发症--包括穿孔、坏疽、脓肿或肿瘤)均已确定:在 3512 名符合条件的患者中,选出了 3085 名阑尾炎患者,并纳入了 380 名有阑尾结石且有 CT 图像可供重新评估的患者。在 3085 名经 CT 诊断为急性阑尾炎的患者中,有 1101 人(35.7%)同时患有急性阑尾炎和阑尾结石,其中有 519 人(47.1%)患有复杂性急性阑尾炎。在没有阑尾结石的患者(1984 人)中,426 人(21.5%)患有复杂性阑尾炎(P < 0.001)。重新评估380名患者的CT图像显示,阑尾结石直径较大(OR = 1.15 (95% c.i. 1.06 to 1.25);P < 0.001)、阑尾结石位于阑尾底部(55.1% 对 44.9%;P = 0.008)和阑尾结石周围阑尾壁异质强化(68.4% 对 31.6%;P < 0.001)与并发急性阑尾炎的风险增加有关:结论:急性阑尾炎患者出现阑尾结石与并发阑尾炎的风险相关。结论:急性阑尾炎患者出现阑尾结石与并发阑尾炎的风险相关,阑尾结石直径较大或结石位于阑尾底部会进一步增加并发阑尾炎的风险。
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Impact of an appendicolith and its characteristics on the severity of acute appendicitis.

Background: Antibiotics have been reported as an efficient and safe treatment option for uncomplicated acute appendicitis without an appendicolith diagnosed using computed tomography (CT). The aim of this study was to assess the association of a CT-diagnosed appendicolith and its characteristics with appendicitis severity.

Methods: A large prospective patient cohort with suspected acute appendicitis enrolled between April 2017 and November 2018 was retrospectively reviewed. The initial analysis evaluated the association of a CT-diagnosed appendicolith with complicated acute appendicitis; then, based on the availability of CT images, a subset of patients was analysed for the correlation of appendicolith characteristics with appendicitis severity. The final appendicitis assessment (uncomplicated or complicated-including perforation, gangrene, an abscess, or a tumour) was determined for all patients.

Results: Out of 3512 eligible patients, 3085 patients with appendicitis were selected and 380 patients with an appendicolith and with a CT image available for reassessment were included. Out of the 3085 patients with CT-diagnosed acute appendicitis, 1101 (35.7%) patients presented with both acute appendicitis and an appendicolith and, out of these, 519 (47.1%) had complicated acute appendicitis. In the patients without an appendicolith (1984 patients), 426 (21.5%) had complicated appendicitis (P < 0.001). Re-evaluation of CT images for 380 patients showed that a larger appendicolith diameter (OR = 1.15 (95% c.i. 1.06 to 1.25); P < 0.001), appendicolith location at the base of the appendix (55.1% versus 44.9%; P = 0.008), and heterogeneous appendiceal wall enhancement around the appendicolith (68.4% versus 31.6%; P < 0.001) were associated with an increased risk of complicated acute appendicitis.

Conclusion: The presence of an appendicolith in patients with acute appendicitis is correlated with the risk of complicated appendicitis. This risk is further increased by a larger appendicolith diameter or appendicolith location at the base of the appendix.

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BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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