粪石性阑尾炎临床与病理特征分析

Analysis of Clinical and Pathological Features of Acute Appendicitis with Appendicolith

摘要: 目的：阑尾粪石(appendicolith)是急性阑尾炎的重要病因之一。目前，关于阑尾粪石与复杂性阑尾炎(complicated appendicitis)的关系尚无共识，对于合并阑尾粪石的阑尾炎治疗意见也存在分歧。本研究旨在确定阑尾粪石在急性复杂性阑尾炎中的意义，并评估与复杂性阑尾炎相关的阑尾粪石的特征和计算机断层扫描(computed tomography, CT)征象。方法：对2016年1月至2023年10月期间在青岛大学附属医院接受急性阑尾炎手术治疗的患者进行回顾性分析。根据CT检查结果、术中观察和术后组织病理学结果，将急性阑尾炎分为有阑尾粪石和无阑尾粪石两组，对两组患者的临床资料进行分析和比较。在有阑尾粪石组内，根据病理学发现进行进一步的亚组分析，比较阑尾粪石的位置、大小和数量，以及阑尾的长度、直径和CT特征。结果：在331例急性阑尾炎患者中，179例存在阑尾粪石，其中106例为复杂性阑尾炎，73例为非复杂性阑尾炎(uncomplicated appendicitis)。在152例不含阑尾粪石的患者中，44例为复杂性阑尾炎，108例为非复杂性阑尾炎。阑尾粪石与复杂性阑尾炎独立相关(比值比OR = 1.88, 95%置信区间(95% confidence interval, 95% CI): 1.04~3.40, P = 0.036)。在合并阑尾粪石的阑尾炎患者中，三个因素与复杂性阑尾炎独立相关，分别为：阑尾直径增大(OR = 1.20; 95% CI: 1.03~1.40)、中重度脂肪条束征(fat stranding) (OR = 17.61; 95% CI: 3.19~97.33)和阑尾周围气体影(OR = 9.78; 95% CI: 1.17~81.46)。结论：阑尾粪石与急性复杂性阑尾炎密切相关。阑尾直径、CT检查中的中重度脂肪条束征和阑尾周围气体影是识别合并阑尾粪石的急性阑尾炎中复杂性阑尾炎的重要指标。

Abstract: Purpose: Appendicoliths are one of the important causes of acute appendicitis. Currently, there is no consensus on the relationship between appendicoliths and complicated appendicitis, and opinions on the treatment of appendicolith-associated appendicitis vary. This study aims to determine the significance of appendicolith in acute complicated appendicitis and assess the characteristics of appendicoliths and computed tomography (CT) features associated with complicated appendicitis. Methods: A retrospective analysis was conducted on patients who underwent surgical treatment for acute appendicitis at the Affiliated Hospital of Qingdao University from January 2016 to October 2023. Acute appendicitis was classified into two groups with and without appendicolith based on CT findings, intraoperative observations, and postoperative pathology. The clinical data of the two groups were analyzed and compared. Further subgroup analysis was performed within the appendicolith group based on pathological findings, comparing the location, size, and number of appendicoliths, as well as the length, diameter, and CT features of the appendix. Results: Among 331 patients with acute appendicitis, 179 had appendicolith, of which 106 were complicated appendicitis and 73 were uncomplicated appendicitis. Among 152 patients without appendicolith, 44 had complicated appendicitis and 108 had uncomplicated appendicitis. Appendicoliths were independently associated with complicated appendicitis (OR = 1.88, 95% confidence interval (95% CI): 1.04~3.40, P = 0.036). In patients with appendicolith appendicitis, three factors were independently associated with complicated appendicitis: increased appendiceal diameter (OR = 1.20; 95% CI: 1.03~1.40), moderate-severe fat stranding (OR = 17.61; 95% CI: 3.19~97.33), and periappendiceal air (OR = 9.78; 95% CI: 1.17~81.46). Conclusion: Appendiceal appendicoliths are closely related to acute complicated appendicitis. The diameter of the appendix and moderate-severe fat stranding and periappendiceal air on CT are significant indicators for identifying complicated appendicitis in acute appendicitis with appendicolith.