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首页> 外文期刊>Surgical Endoscopy >Selective use of diagnostic laparoscopy in patients with suspected appendicitis.
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Selective use of diagnostic laparoscopy in patients with suspected appendicitis.

机译：疑似阑尾炎患者应选择性使用诊断性腹腔镜检查。

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BACKGROUND: Diagnostic laparoscopy has been introduced as a new diagnostic tool for patients with acute appendicitis. We performed diagnostic laparoscopy when the clinical diagnosis of appendicitis was in doubt. The aims of this study were to evaluate this strategy and to analyze the efficacy of diagnostic laparoscopy in patients with suspected appendicitis. PATIENTS AND METHODS: All patients referred to our hospital with suspected appendicitis during the period 1994-1997 were evaluated prospectively. The clinical diagnosis was determined by the surgeon or resident on call based on the patient's history, physical examination, and leukocyte count. The patients were divided into three groups: group 1: appendicitis not likely. These patients were observed for 24 h or discharged. When they showed signs of appendicitis in 24 h, they were transferred to either group 2 or 3; group 2: doubt concerning diagnosis. These patients underwent diagnostic laparoscopy, and appendectomy was performed if indicated; group 3: In these patients the diagnosis appendicitis was felt to be certain. They were treated by primary appendectomy by an open procedure. In this study, 1,050 patients, 531 women (51%), 389 men (37%), and 130 children (12%) <11 yrs, were evaluated. RESULTS: Altogether, 377 diagnostic laparoscopies were performed, leaving 109 healthy-looking appendices in place. This reduced the negative appendectomy rate from 25% to 14% in all surgically managed patients. The negative appendectomy rate for the women in group 2 was reduced from 49% to 14%, and for the men from 22% to 11%, so it also seemed worthwhile to perform diagnostic laparoscopy in men. Because the appendix sana was left in place in only three children, the benefit from laparoscopy is relatively small for children. In 48% of these patients a second diagnosis was obtained, most of them gynecologic in nature. There were no false-negative laparoscopies and no complications resulting from the laparoscopic procedure. CONCLUSIONS: Diagnostic laparoscopy is a safe procedure that reduced the appendix sana rate without increasing the total number of operations. It is a useful method for obtaining other, mostly gynecologic, diagnoses. To further reduce the appendix sana rate, better criteria for laparoscopic assessment of the appendix are needed.
机译：背景：腹腔镜诊断已经被引入作为急性阑尾炎患者的一种新的诊断工具。当对阑尾炎的临床诊断有疑问时，我们进行了诊断性腹腔镜检查。这项研究的目的是评估这种策略，并分析诊断性腹腔镜检查在可疑阑尾炎患者中的疗效。病人与方法：对1994-1997年期间转诊到我们医院的所有怀疑为阑尾炎的患者进行了前瞻性评估。临床诊断由外科医生或住院医生根据患者的病史，体格检查和白细胞计数确定。将患者分为三组：第1组：不太可能发生阑尾炎。观察这些患者24小时或出院。当他们在24小时内显示出阑尾炎的迹象时，将他们转移到第2或第3组中。第二组：对诊断的怀疑。这些患者接受了诊断性腹腔镜检查，如果有指征，则进行阑尾切除术。第3组：在这些患者中，感觉阑尾炎的诊断是确定的。他们通过开放式原发性阑尾切除术进行了治疗。在这项研究中，对1,050名患者，531名女性（51％），389名男性（37％）和130名儿童（12％）<11岁进行了评估。结果：总共进行了377例诊断性腹腔镜检查，保留了109个看起来健康的阑尾。这将所有手术治疗患者的阴性阑尾切除率从25％降低到14％。第2组女性的阴性阑尾切除率从49％降低至14％，男性从22％降低至11％，因此对男性进行诊断性腹腔镜检查似乎也值得。由于阑尾纱罗仅留在三个儿童中，因此腹腔镜检查对儿童的益处相对较小。在这些患者中有48％获得了第二次诊断，其中大多数是妇科性质的。没有假阴性的腹腔镜检查，也没有因腹腔镜手术引起的并发症。结论：诊断性腹腔镜检查是一种安全的程序，可降低阑尾假手术率，而无需增加手术总数。这是获得其他（主要是妇科）诊断的有用方法。为了进一步降低阑尾假名率，需要更好的腹腔镜阑尾评估标准。

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