臨床急性闌尾炎之描述流行病學研究：某區域教學醫院的二年經驗

A Descriptive Epidemiologic Study on the Patients with Clinically Suspected Acute Appendicitis - 2 years Surgical Experience in a Local Teaching Hospital

目的：對急性闌尾炎而言，手術切除是最直接有效的方法，然而，大約有三成的病人，在手術中發現其闌尾是正常的。所以，若能在手術前能做好適當的鑑別診斷，在臨床上是相當有運用價值的。方法：我們利用回溯的追蹤方式，一共收集217位因為懷疑急性闌尾炎而接受手術的病人，包括95位女性與122位男性，他們的平均年齡是36歲。在確定為急性闌尾炎與正常者的兩組病人中，我們分析了其臨床參數的異同。結果：在手術中，我們發現有48位病人（22.1%）他們的闌尾是正常的，可能是其他的原因造成我們診斷不正確，其中，又以女病人所發生的比例較高（p=0.021）。經由分析我們發現，真正急性闌尾炎的病患，具有從肚臍周圍向右下腹轉移的典型腹痛是很重要的理學檢查（p=0.055）。大部分真正闌尾炎的病患，其血液中白血球（p=0.001）與嗜中性血球的數目都是偏高的（p<0.001）。術後有22位病（10.1%）患發生感染的現象，而感染的機率與術中拭管細菌培養的陽性表現有高度的相關性（p<0.001）。在培養出的60種細菌中，以大腸桿菌是最常見的。有19位病人，在術中我們發現他們併發闌尾破裂。結論：是否具有典型的腹痛，病患的性別，血液中偏高的白血球與嗜中性血球的數目是幫忙我們鑑別診斷急性闌尾炎的重要臨床參數。

Objectives. Between 15% and 30% of patients treated surgically for clinically suspected acute appendicitis (CSAA) are found to have a normal appendix during appendectomy. Therefore, it would be clinically relevant to be able differentiate true acute appendicitis (TAA) from negative acute appendicitis (NAA) before surgery is prescribed. Methods. For this two-year descriptive study, we retrospectively reviewed the medical charts of 217 CSAA patients (122 men and 95 women) with a mean age of 36.0 receiving appendectomies in Keelung Hospital. Possible clinical variables that can differentiate TAA from NAA patients were evaluated and compared. Results. In tota148 (22.1%) patients were found to have NAA, especially the female patients (28/95 for female vs. 20/122 for male, p=0.021). The initial clinical symptom of central / peri-umbilical abdomenal pain with a shifting to the right lower quadrate of the abdomen was a significant predictor for TAA (p=0.055). TAA patients had a significantly higher white blood cell (WBC) count (p=0.001) and higher percentage of differential neutrophil count (p<0.001 ). Twenty-two (10.1%) patients developed post-operative infections, especially those with positive cultures (p<0.001). Sixty bacteria were identified, E. coli (n=21) being the most common (35.0%). Nineteen patients developed a ruptured TAA. Conclusions. The initial clinical symptom of central I peri-umbilical abdominal pain, sex gender, and percentage of differential neutrophil counts were found as independent predictors of TAA from NAA. The variables may be used to differentiate TAA for NAA.