术前延迟时间对急性阑尾炎临床经过的影响  

Influence of preoperative delay on clinical course of acute appendicitis

作　　者：柏志斌[1] 汤文浩[1] 陈卫东[1] 肖家全[1] 蒋小华[1] 

机构地区：[1]东南大学附属中大医院普外科,江苏南京210009

出　　处：《中国现代医学杂志》2010年第18期2809-2812,共4页China Journal of Modern Medicine

摘　　要：目的探讨术前延迟时间对急性阑尾炎临床经过的影响。方法回顾性分析1998年1月～2007年12月,该院连续收治的2 107例术前诊断为急性阑尾炎而接受了阑尾切除术的患者资料。将患者按术前延迟时间的不同分为<12 h、12～24 h、24～36 h、36～48 h、48～72 h和>72 h 6个组,分析不同的术前延迟时间与急性阑尾炎病理结果、术后住院时间、术后发热时间、抗生素治疗时间及术后并发症的关系。结果总的诊断准确率为85.7%。术前延迟时间(主要是入院前延迟时间)对急性阑尾炎病理结果有显著影响(P<0.0001),而入院后延迟时间对其影响无显著性。随着术前延迟时间的增加,发生晚期阑尾炎的风险逐渐上升(P<0.0001)。术后住院时间、术后发热时间、抗生素治疗时间以及术后并发症的发生率与术前延迟时间呈正相关。结论对于急性阑尾炎患者,延迟手术是不安全的。降低晚期阑尾炎发生率应着眼于入院前的处理。【Objective】 To investigate the effect of preoperative delay on the clinical course in patients with acute appendicitis.【Methods】The data of 2107 patients who received appendectomy in Zhongda Hospital affiliated to Southeast University between January 1998 and December 2007 for suspected acute appendicitis were retrospective-ly analyzed.The patients were divided into six groups based on preoperative time（12 h,12~24 h,24~36 h,36~48 h,48~72 h and 72 h）,the changes in outcomes such as the result of pathology,duration of post-operative hospital stay,duration of occurrence of postoperative fever,antibiotic treatment and postoperative complications were ana-lyzed.【Results】The total diagnostic accuracy was 85.67 %.The mean total delay from onset of symptoms to ap-pendectomy was 1.72 times longer in the advanced appendicitis group than that of the early inflamed group（P 0.001）.The risk of advanced pathology increased with the total delay（P 0.001） and the preadmission delay（P 0.001）.Postoperative delay had no significant effect on the pathology of appendicitis in the study groups.Increased duration of postoperative stay,use of antibiotics,and duration of occurrence of postoperative fever as well as the rate of postoperative complications were positively correlated with increasing preoperative time.【Conclusion】Delayed appendectomy is unsafe.The decreased rate of advanced pathology and improved postoperative events depend on the preadmission management.

关 键 词：急性阑尾炎 阑尾切除术 延迟 临床经过 

分 类 号：R574.61[医药卫生—消化系统]