中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2014年
5期
338-341
,共4页
阑尾炎%阑尾切除术%因素分析,统计学
闌尾炎%闌尾切除術%因素分析,統計學
란미염%란미절제술%인소분석,통계학
Appendicitis%Appendectomy%Factor analysis,statistical
目的 探讨成人急性复杂型阑尾炎的临床特征.方法 回顾性分析2003年1月至2012年12月手术切除的742例急性阑尾炎病例,根据术后病理结果分为急性单纯性阑尾炎组和急性复杂型阑尾炎组.比较2组患者的一般情况、临床表现、体检结果、实验室检查及影像学检查结果,寻找急性复杂型阑尾炎的临床规律.结果 本组患者中急性复杂型阑尾炎533例(71.8％),病理类型包括急性化脓性阑尾炎306例,急性蜂窝织性阑尾炎57例,阑尾穿孔59例,急性坏疽性阑尾炎100例,阑尾穿孔伴脓肿形成6例,阑尾炎合并肿瘤5例.较之单纯性阑尾炎,成人急性复杂型阑尾炎入院时白细胞计数更高(t=-7.142,P=0.000),体检发现腹肌紧张者较多(x2=10.646,P=0.000),B超或CT提示阑尾内有粪石嵌顿(x2=16.759,P=0.000)、右下腹局部积液者较多(x2=13.531,P=0.000).多因素Logistic回归分析表明,无阑尾炎病史(OR=0.593,95％CI:0.373～0.942)、白细胞计数高于20×109/L(OR =2.717,95％ CI:1.834 ～4.027)、腹肌紧张(OR=1.649,95％CI:1.047～2.597)、B超或CT发现阑尾内粪石嵌顿(OR=2.939,95％CI:1.607～5.377)及阑尾周围积液(OR=3.273,95％CI:1.424 ～7.525)是成人急性复杂型阑尾炎的主要危险因素(P＜0.05).结论 白细胞计数显著增高、腹部体检触及肌紧张、影像学检查发现阑尾粪石或阑尾周围积液对鉴别成人急性单纯性和复杂型阑尾炎有较大意义.
目的 探討成人急性複雜型闌尾炎的臨床特徵.方法 迴顧性分析2003年1月至2012年12月手術切除的742例急性闌尾炎病例,根據術後病理結果分為急性單純性闌尾炎組和急性複雜型闌尾炎組.比較2組患者的一般情況、臨床錶現、體檢結果、實驗室檢查及影像學檢查結果,尋找急性複雜型闌尾炎的臨床規律.結果 本組患者中急性複雜型闌尾炎533例(71.8％),病理類型包括急性化膿性闌尾炎306例,急性蜂窩織性闌尾炎57例,闌尾穿孔59例,急性壞疽性闌尾炎100例,闌尾穿孔伴膿腫形成6例,闌尾炎閤併腫瘤5例.較之單純性闌尾炎,成人急性複雜型闌尾炎入院時白細胞計數更高(t=-7.142,P=0.000),體檢髮現腹肌緊張者較多(x2=10.646,P=0.000),B超或CT提示闌尾內有糞石嵌頓(x2=16.759,P=0.000)、右下腹跼部積液者較多(x2=13.531,P=0.000).多因素Logistic迴歸分析錶明,無闌尾炎病史(OR=0.593,95％CI:0.373～0.942)、白細胞計數高于20×109/L(OR =2.717,95％ CI:1.834 ～4.027)、腹肌緊張(OR=1.649,95％CI:1.047～2.597)、B超或CT髮現闌尾內糞石嵌頓(OR=2.939,95％CI:1.607～5.377)及闌尾週圍積液(OR=3.273,95％CI:1.424 ～7.525)是成人急性複雜型闌尾炎的主要危險因素(P＜0.05).結論 白細胞計數顯著增高、腹部體檢觸及肌緊張、影像學檢查髮現闌尾糞石或闌尾週圍積液對鑒彆成人急性單純性和複雜型闌尾炎有較大意義.
목적 탐토성인급성복잡형란미염적림상특정.방법 회고성분석2003년1월지2012년12월수술절제적742례급성란미염병례,근거술후병리결과분위급성단순성란미염조화급성복잡형란미염조.비교2조환자적일반정황、림상표현、체검결과、실험실검사급영상학검사결과,심조급성복잡형란미염적림상규률.결과 본조환자중급성복잡형란미염533례(71.8％),병리류형포괄급성화농성란미염306례,급성봉와직성란미염57례,란미천공59례,급성배저성란미염100례,란미천공반농종형성6례,란미염합병종류5례.교지단순성란미염,성인급성복잡형란미염입원시백세포계수경고(t=-7.142,P=0.000),체검발현복기긴장자교다(x2=10.646,P=0.000),B초혹CT제시란미내유분석감돈(x2=16.759,P=0.000)、우하복국부적액자교다(x2=13.531,P=0.000).다인소Logistic회귀분석표명,무란미염병사(OR=0.593,95％CI:0.373～0.942)、백세포계수고우20×109/L(OR =2.717,95％ CI:1.834 ～4.027)、복기긴장(OR=1.649,95％CI:1.047～2.597)、B초혹CT발현란미내분석감돈(OR=2.939,95％CI:1.607～5.377)급란미주위적액(OR=3.273,95％CI:1.424 ～7.525)시성인급성복잡형란미염적주요위험인소(P＜0.05).결론 백세포계수현저증고、복부체검촉급기긴장、영상학검사발현란미분석혹란미주위적액대감별성인급성단순성화복잡형란미염유교대의의.
Objective To find out the clinical and pathological characteristics in acute complicated appendicitis.Methods A retrospective clinical analysis was made on 742 cases of acute appendicitis from January 2003 to December 2012.All cases underwent appendectomy.Patients were allocated to the acute complicated appendicitis (ACA) group and the acute uncomplicated appendicitis group based on pathological reports.The x2 test was used to check for differences between proportions.Multivariate analysis was made through the Logistic regression.Results Of 742 patients,533 were allocated to the ACA group,including acute suppurative appendicitis 306 patients,acute gangrenous appendicitis 100 patiets,appendicitis with perforation 59 patients,appendicitis with abscess formation 6 patients and appendicitis with tumor 5 patients.Statistical result shows that the patients of ACA group usually had higher toal WBC count,local or diffuse muscle guarding,intraluminal stercolith or periappendiceal fluid.Logistic regression also indicated that ACA were mathematically related to high level white blood cell count (＞ 20 × 109/L,OR =2.717,95％ CI:1.834-4.027,P ＜0.05),local or diffuse muscle guarding (OR =1.649,95％ CI:1.047-2.597,P ＜ 0.05),intraluminal stercolith (OR =2.939,95 ％ CI:1.607-5.377,P ＜ 0.05) and periappendiceal fluid (OR=3.273,95％C1:1.424-7.525,P＜0.05).Conclusions Patients with high level WBC count,local or diffuse muscle guarding,intraluminal stercolith or periappendiceal fluid are likely suffering from acute complicated appendicitis.Appendectomy must be considered as first-line therapy other than conservative antibiotic therapy under these situations.
