目的 探讨急性阑尾炎手术后切口感染的相关因素。方法 观察我院2002年5月至2007年5月期间收治的665例急性阑尾炎患者采用术前预防使用抗生素、术中保护切口、术后加强切口管理等处理后切口感染情况，并分析切口感染与阑尾炎的病程、手术时间、切口选择、留置引流和病理类型之间的关系。结果 本组患者中32例发生切口感染，感染率为4.81% (32/665)，急性阑尾炎术后切口感染与性别无关（ P ＞ 0.05），与病程长短、切口选择、手术时间、腹腔留置引流与否以及病理类型均有关（ P ＜ 0.01）。结论 病程长、手术时间久、炎症较重的急性阑尾炎病例切口感染率较高； 做好围手术期的处理，术中尽量保护切口可以降低切口感染率。
Objective To investigate the variation of total hospitalization cost for single-diagnosed disease of different types of acute appendicitis in a three-A hospital, so as to provide evidence for the reimbursement amount of social medical insurance. Methods All patients with acute appendicitis who had surgery treatment during January-April 2011 (before implementing the fee system for single-diagnosed disease) and January-April 2012 (after implementing the fee system for single-diagnosed disease) were collected in this study for analysis. According to the types of acute appendicitis, the patients were stratified into the low risk group (simple, suppurative and gangrenous) and the high risk group (perforative, abscess-formed and pregnancy-combined). The correlation between total hospitalization cost and types of acute appendicitis, as well as the changes of total hospitalization cost after implementing the fee system for single-diagnosed disease were analyzed. Results A total of 90 eligible patients were included. The disease types were positively correlated with hospital stays and total hospitalization cost. All three types in the low risk group could control the average total hospitalization cost within RMB 10 000 yuan. The results of sensitivity analysis showed that, before implementing the fee system for single-diagnosed disease, the total hospitalization cost up to RMB 6 000 yuan could be positively correlated with the above risk stratification (r=0.442, P=0.003). After implementing the fee system for single-diagnosed disease from January to April 2012, the constituent ratio of hospital stays, compared with that in the same period of 2011, had no significant difference (P=0.108) between the two groups; but the ratio of hospital stays (less than 5 days) increased from 45% to 64%, and the ratio of hospital stays (greater than or equal to 10 days) decreased from 17% to 4%, indicating a tendency of shortening hospital stays. Also, the constituent ratio of total hospitalization cost had no significant difference (P=0.114) between the two groups; but the ratio of total hospitalization cost (greater than or equal to RMB 9 000 yuan) decreased from 32% to 13%, indicating a tendency of lowering total hospitalization cost. Conclusion The low risk group of acute appendicitis, RMB 6 000 yuan should be rated as the rational reimbursement amount of social medical insurance. The total hospitalization cost for the high risk group is quite various, so the further studies are needed to investigate the feasibility of the fee system for single-diagnosed disease as well as the rating amount of total hospitalization cost. The implementation of the fee system for single-diagnosed disease is helpful to shorten hospital stays and reduce total hospitalization cost.
截止至2002年6月,有关阑尾炎治疗的临床证据如下:①辅助性抗生素治疗:1项RCT和1项回顾性RCT发现,经阑尾切除术的复杂性和单纯性阑尾炎的成人和儿童,预防性使用抗生素可显著减少伤口感染和腹腔内脓肿.②辅助性抗生素治疗(儿童复杂性阑尾炎):1项系统评价的亚组分析发现,使用抗生素可显著减少伤口感染.③辅助性抗生素治疗(儿童单纯性阑尾炎):1项系统评价的亚组分析发现,使用抗生素不减少伤口感染.1项儿童单纯性阑尾炎的回顾性RCT发现,预防性使用抗生素不能减少伤口感染,但该RCT的样本量太小,不能排除有临床差别.④抗生素治疗和手术:1项成人疑诊阑尾炎的RCT发现,与手术治疗比较,抗生素保守治疗可减少治疗开始后12 h到10 d的疼痛和吗啡的使用.但采取抗生素保守治疗的患者有35%在1年内再次因急性阑尾炎入院,并行阑尾切除术.⑤腹腔镜手术和开腹手术(成人):1项系统评价发现,腹腔镜手术可以减少伤口的感染,减轻手术后第1天的疼痛,减少住院时间以及恢复工作的时间,但增加手术后腹腔内脓肿的发生.⑥腹腔镜手术和开腹手术(儿童):1项系统评价发现,腹腔镜手术可以减少伤口的感染,减少住院时间,但不能减轻手术后第1天的疼痛,不能减少恢复的时间和腹腔内脓肿的发生.⑦开腹手术和不治疗:无RCT证据.⑧开腹阑尾切除术中对残端的内翻处理:1项RCT发现,两次包埋和单纯结扎比较,不能减少伤口的感染、住院时间和腹腔内脓肿的发生.
目的 分析其他疾病误诊为急性阑尾炎的原因。方法 结合相关文献资料，对2004年2月至2008年12月期间本院21例其他疾病被误诊为急性阑尾炎的过程进行回顾性分析。结果 除了胆囊结石、胃穿孔、肠结核、异位妊娠等常见病可能被误诊为急性阑尾炎外，肝包虫、胆管癌、癔病、恶性淋巴瘤等也有可能被误诊为急性阑尾炎。误诊的主要原因是经治医生经验不足、思维局限、知识面狭窄，更重要的则是重视不足，检查不仔细、不全面。结论 系统和全面仔细地问诊、查体，努力提高辅助检查诊断水平等是减少误诊的关键。
目的 比较低频与高频探头超声对急性阑尾炎的诊断价值。 方法 对2010年1月－2011年6月120例急性阑尾炎的手术病理结果与超声检查结果进行回顾性分析，比较低、高频探头超声对急性阑尾炎的诊断价值。 结果 120例急性阑尾炎中，通过低频探头超声检出67例（55.8%），通过高频探头超声检出105例（87.5%）；单纯性阑尾炎以及化脓性和坏疽性阑尾炎高频探头超声检出例数明显大于低频探头超声，差异有统计学意义（P＜0.05）；阑尾周围脓肿低、高频探头超声均全部检出。 结论 高频探头超声对急性阑尾炎的检出率高于低频探头超声，但二者各有所长，在临床中联合应用能有效提高急性阑尾炎的超声诊断符合率。
ObjectiveTo study the diagnostic significance of modified Alvarado Score System for different types of acute appendicitis. MethodsClinical data of 1 930 cases of acute appendicitis, who underwent appendicectomy in The First Hospital of Yulin from Jan. 2004 to Jan. 2014, were retrospectively collected. Then the diagnostic significance of Modified Alvarado Score System was detected and evaluated by receiver operating characteristic (ROC) curve, and its correlation with postoperative pathological results was calculated. ResultsThe modified Alvarado score of cases in progressive group was higher than that of simplex group (7.5±1.3 vs. 3.6±0.7, P < 0.001). The areas under ROC curve of modified Alvarado Score System was 0.943 (95% CI:0.929-0.958, P < 0.001). The critically diagnostic points of Modified Alvarado Score System for differential diagnosis of simplex acute appendicitis and progressive acute appendicitis was 6 score, with sensitivity of 92.9%, specificity of 86.3%, positive predictive value of 96.9%, negative predictive value of 72.6%, positive likelihood ratio of 6.8, negative likelihood ratio of 0.1, and Youden index of 91.7%. ConclusionThis Modified Alvarado Score System has a certain significance for the type diagnosis of acute appendicitis.