复发性阑尾炎的临床特征分析  

Clinical characteristics of recurrent appendicitis

作　　者：李世宽[1] 李春桥[1] 李元博[1] 宁亮[1] 于宗平 王培戈[1] 周晓斌 任建安 Li Shikuan;Li Chunqiao;Li Yuanbo;Ning Liang;Yu Zongping;Wang Peige;Zhou Xiaobin;Ren Jian′an(Department of Emergency Surgery,the Affiliated Hospital of Qingdao University,Qingdao,Shandong 266003,China;Department of Epidemiology and Health Statistics,School of Public Health of Qingdao University,Qingdao,Shandong 266021,China;Department of General Surgery,Jinling Hospital,Nanjing University Medical School,Nanjing,Jiangsu 210002,China)

机构地区：[1]青岛大学附属医院急诊普通外科,266003 [2]青岛大学公共卫生学院流行病与卫生统计学系,266021 [3]南京大学医学院附属金陵医院(东部战区总医院)普通外科,南京210002

出　　处：《中华胃肠外科杂志》2020年第8期786-790,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的阑尾炎的复发是急性阑尾炎治疗临床决策时要考虑的重要问题。本文分析复发性阑尾炎的临床特征,以期加深对阑尾炎复发的认识。方法采用回顾性队列研究方法,收集青岛大学附属医院2011年1月至2015年12月期间,因急性阑尾炎住院行阑尾切除术(包括开放与腹腔镜手术)并经病理确诊的急性阑尾炎患者的临床资料。排除标准:(1)年龄<18岁;(2)慢性阑尾炎;(3)阑尾周围脓肿;(4)阑尾黏液囊肿或阑尾黏液性肿瘤;(5)阑尾神经内分泌肿瘤或阑尾癌;(6)妊娠期阑尾炎;(7)合并获得性免疫缺陷综合征、严重血液系统疾病、自身免疫性疾病、炎性肠病、进展期癌症;(8)同期实施其他手术。共计373例患者纳入本研究,根据既往有无阑尾炎发作并有无抗生素治疗病史,将患者分为复发组(133例)和初发组(240例)。分析复发性阑尾炎患者的临床特征,包括性别、年龄、合并症及术前CT影像等资料。结果373例急性阑尾炎患者中,男性209例,女性164例,中位年龄42(18~88)岁。复发组中位复发时间为4(1~60)个月。与初发组相比,复发组年龄<50岁者比例[71.4%(95/133)比57.5%(138/240),χ^2=7.081,P=0.008],合并糖尿病者比例更高[13.5%(18/133)比5.4%(13/240),χ^2=7.399,P=0.007],发病时间更短[(41.7±13.6)h比(59.4±56.2)h,t=-3.286,P=0.001]、腹肌紧张或反跳痛比例更低[57.9%(77/133)比66.7%(160/240),χ^2=5.065,P=0.024]、改良Alvarado评分更低[(5.6±1.9)分比(6.1±1.9)分,t=-2.417,P=0.016]、白细胞计数更低[(10.5±4.6)×10^9/L比(11.5±4.5)×10^9/L,t=-1.190,P=0.047]、淋巴细胞计数百分比更高[(19.4±14.7)%比(16.1±13.3)%,t=2.069,P=0.039],差异均有统计学意义(均P<0.05)。复发组中,阑尾长度≥7 cm者比例高于初发组[44.4%(59/133)比32.9%(79/240),χ^2=4.808,P=0.028],复杂性阑尾炎的比例低于初发组[8.3%(11/133)比22.9%(55/240),χ^2=10.823,P=0.001],差异均有统计学意义(均P<0.05)。在129例可查阅CT影像的患者,�Objective To analyze clinical characteristics of recurrent appendicitis.Methods A retrospective cohort study was carried out.Clinical data of patients who underwent appendectomy due to acute appendicitis confirmed by pathology in the Affiliated Hospital of Qingdao University from January 2011 to December 2015 were analyzed retrospectively.Exclusion criteria:(1)age of less than 18 years;(2)chronic appendicitis;(3)periappendiceal abscess;(4)appendiceal mucocele or mucinous neoplasms;(5)appendiceal neuroendocrine tumors or cancers;(6)appendicitis during pregnancy;(7)concurrent AIDS,hematological disease,autoimmune disease,inflammatory bowel disease or advanced cancer;(8)other simultaneous surgery.A total of 373 patients were enrolled the study.These patients were divided into the recurrent group(133 cases)and the first episode group(240 cases)according to the previous history of antibiotic therapy for acute appendicitis.The prevalence of recurrent appendicitis was calculated,and the clinical characteristics were analyzed,including gender,age,comorbidities and preoperative CT images.Results Of 373 patients,209 were male and 164 were female,with a median age of 42(18 to 88)years.Median recurrent time of the recurrent group was 4(1 to 60)months.Compared to the first episode group,the recurrent group had higher proportion of age<50 years[71.4%(95/133)vs.57.5%(138/240),χ^2=7.081,P=0.008],higher proportion of concurrent diabetes[13.5%(18/133)vs.5.4%(13/240),χ^2=7.399,P=0.007],shorter onset time[(41.7±13.6)hours vs.(59.4±56.2)hours,t=-3.286,P=0.001],lower proportion of abdominal tension and rebound pain[57.9%(77/133)vs.66.7%(160/240),χ^2=5.065,P=0.024],lower score of modified Alvarado score[(5.6±1.9)point vs.(6.1±1.9)point,t=-2.417,P=0.016],lower WBC count[(10.5±4.6)×10^9/L vs.(11.5±4.5)×10^9/L,t=-1.190,P=0.047],higher percentage of lymphocyte[(19.4±14.7)%vs.(16.1±13.3)%,t=2.069,P=0.039].In the recurrent group,ratio of length of removed appendix≥7 cm was higher as compared with the first episode group[44.4%(

关 键 词：阑尾炎 复发性 阑尾炎 急性 手术 保守治疗 

分 类 号：R656.8[医药卫生—外科学]