与负尾切除率相关的危险因素:一项回顾性队列研究
Neil Donald1, Laura Halliday1,2, Gillian Smith1
1General Surgery, Dartford and Gravesham NHS Trust, Dartford, GBR.
Cureus
|August 14, 2024
概括
诊断急性尾炎 (AA) 是一个挑战. 这项研究发现,结合临床,生化和放射学因素可以提高诊断确定性,但常规实践中的成像性能与文献不同,导致高负尾切除率.
科学领域:
- 一般外科 整体外科
- 诊断成像 诊断成像 诊断成像
- 病理学 病理学 病理学
背景情况:
- 急性尾炎 (AA) 是一种常见的手术紧急情况,需要准确的诊断.
- 目前的诊断方法涉及临床评估,生化标志物和成像,但准确性仍然是一个挑战.
- 这项研究评估了英国常规实践中的诊断方法.
研究的目的:
- 调查在英国单中心环境中广泛使用的急性尾炎诊断方法的诊断效用.
- 分析与AA相关的因素以及生物化学和放射学调查的表现.
- 在例行实践中评估负尾切除率 (NAR).
主要方法:
- 对330名因疑似AA而接受腹腔镜尾切除术的患者进行了回顾性观察队列研究 (2022年4月 - 2023年3月).
- 通过转移性多态核白细胞定义的AA的组织学确认.
- 儿科患者的子组分析;相关因素的调查和诊断测试实用性.
主要成果:
- 总体NAR为38% (儿童患者为48%).
- 对AA的独立预测因素包括中性粒细胞数量升高 (OR 4.04),C反应蛋白 (CRP) 升高 (OR 3.04) 和放射性诊断 (OR 8.0).
- 计算机断层扫描 (CT) 显示98%的灵敏度和47%的特异性;超声波显示35%的灵敏度和86%的特异性.
结论:
- 许多因素的结合对于提高AA的诊断确定性至关重要.
- 常规实践成像性能 (灵敏度/特异性) 与公布的数据不同,有助于高NAR.
- 需要进一步的现实研究来验证这些发现,并探索其他环境中的差异.
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