PDF(Pubmed)
Abstract：
Background/Objectives: In patients diagnosed with uncomplicated acute appendicitis (UAA), the absence of calcified deposits or stones, called appendicoliths, often leads to consideration of non-operative treatment (NOT), despite the notable treatment failure rate associated with this approach. Previous research has indirectly estimated the prevalence of appendicoliths to range between 15% and 38% retrospectively by CT scan, intraoperative palpation, and pathology report, thereby potentially missing certain concrements. Our hypothesis proposes that this reported prevalence significantly underestimates the occurrence of appendicoliths, which could explain the high failure rate of 29% of patients with appendicitis observed with NOT. Methods: In our prospective study, conducted with a cohort of 56 adult patients diagnosed with acute appendicitis (AA), we employed intraoperative extracorporeal incisions of the vermiform appendix, in addition to standard diagnostic methods. Results: Our findings revealed 50% more appendicoliths by intraoperative incision (n = 36, p < 0.001) compared to preoperative imaging (n = 24). Appendicoliths were present in 71.4% (n = 40, p < 0.001) of AA patients. Conclusions: These results suggest that conventional diagnostic procedures plausibly underestimate the actual prevalence of appendicoliths, potentially elucidating the frequent treatment failures observed in NOT approaches applied to patients with UAA.
摘要：
背景/目标：在诊断为无并发症急性阑尾炎（UAA）的患者中，没有钙化沉积物或结石，叫做附录，经常导致考虑非手术治疗(NOT)，尽管与这种方法相关的治疗失败率显著。先前的研究通过CT扫描间接估计阑尾的患病率在15％至38％之间。术中触诊,和病理报告，从而可能丢失某些混凝土。我们的假设提出，这种报告的患病率大大低估了阑尾的发生，这可以解释29％的阑尾炎患者的高失败率。方法：在我们的前瞻性研究中，对56名诊断为急性阑尾炎（AA）的成年患者进行了队列研究，我们采用了阑尾的术中体外切口，除了标准的诊断方法。结果：我们的发现显示，与术前成像（n=24）相比，术中切口（n=36，p<0.001）增加了50％。71.4%(n=40,p<0.001)的AA患者存在阑尾结石。结论：这些结果表明，常规诊断程序可能低估了阑尾结石的实际患病率，可能阐明在应用于UAA患者的NOT方法中观察到的频繁治疗失败。
