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題名 | Risk of Complicated Appendicitis and Complications: Time to Hospital or Time to Surgery?=複雜性闌尾炎及術後併發症的危險因子:到院時間或等待手術時間? |
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作者 | 賴碩倫; 吳經閔; 林本仁; | 書刊名 | 中華民國大腸直腸外科醫學會雜誌 |
卷期 | 29:2 2018.06[民107.06] |
頁次 | 頁84-92 |
分類號 | 416.243 |
關鍵詞 | 闌尾炎; 到院時間; 等待手術時間; 複雜性; 併發症; Appendicitis; Time to surgery; Time to hospital; Complicated; Complication; |
語文 | 英文(English) |
中文摘要 | 目的:急性闌尾炎是最常見需要手術的腹部急症之一。然而,早期手術是否對病人有明顯幫助仍有爭議。闌尾炎手術時機由兩因素決定:出現症狀到抵達醫院的時間(到院時間),以及抵達醫院到開始動刀的時間(等待手術時間)。本篇論文旨在探討何種因素會增加複雜性闌尾炎及手術併發症的發生。方法:本篇論文為回溯性研究,收錄自2015/12至2016/12於台大醫院接受闌尾炎手術之病患。本研究將病患先以『出現症狀到抵達醫院的時間大於或小於一天』分為兩個子群,子群中再以『抵達醫院到開始動刀的時間大於或小於12小時』各分做兩個次子群(共四群),接著比較其疾病嚴重度及手術預後是否有差異。結果:本研究共收錄228位病患,其中171位病患出現症狀到抵達醫院的時間小於一天,而57位病患則大於一天。研究結果發現出現症狀到抵達醫院的時間大於一天的病患的複雜性闌尾炎發生率(48.1% vs. 26.9%)、手術時間(78.8 vs. 61.4 min)、住院天數(5.1 vs. 3.4 天)、待院天數(5.8 vs. 4.1天)、發生腹內膿瘍比率(7% vs. 0.6%)顯著增加。而抵達醫院到開始動刀的時間大於或小於12小時則沒有顯著差異。結論:出現症狀到抵達醫院的時間與複雜性闌尾炎發生率、手術時間,住院天數、待院天數、腹內膿瘍發生率有明顯相關。因此根據本研究顯示,相較於等待手術時間,到院時間應為更重要的危險因子。 |
英文摘要 | Purpose. Acute appendicitis is a common cause of acute abdomen requiring surgery. However, it remains controversial whether patients may benefit from early appendectomy. The timing of appendectomy is determined by the time from the onset of symptoms to reaching the hospital (time to hospital) and the time from reaching the hospital to entering the operating room (time to surgery). We aimed to evaluate which period increases the risk for complicated appendicitis and postoperative complications. Methods. We retrospectively reviewed patients who underwent appendectomy for acute appendicitis from December 2015 to December 2016. The demographic characteristics were collected. The patients were divided into two groups: abdominal pain duration (time to hospital) > 1 day and _ 1 day. From each group, the patients were further divided into two subgroups: time to surgery > 12 h and _ 12 h. The disease severity and surgical outcome were respectively compared. Results. Among the 228 patients studied, 171 and 57 had abdominal pain for _ 1 and > 1 day, respectively. Abdominal pain duration (time to hospital) of > 1 day significantly increased the rates of complicated appendicitis (48.1% vs. 26.9%), operative time (78.8 vs. 61.4 min), post-operative hospital admission (5.1 vs. 3.4 days), overall hospital stay (5.8 vs. 4.1 days), and risk of intra-abdominal abscess (7% vs. 0.6%). Regardless of the time to hospital, operative time, disease severity, post-operative hospital admission, and complications were not significantly different between groups with time to surgery of > 12 and ≤ 12 h. Conclusions. Prolonged abdominal pain duration (> 1 day) was associated with an increased risk of complicated appendicitis, longer operative time, post-operative hospital admission, overall hospital stay, and intraabdominal abscess. Regardless of abdominal pain duration, the time to surgery did not significantly affect the disease progression or postoperative complication rates. Our results suggested that the time to hospital has a more important role than time to surgery in the treatment outcome of acute appendicitis. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。