阑尾结石分类:CT 诊断为急性阑尾炎患者阑尾结石的物理和化学特性--一项前瞻性队列研究。

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY
Sanja Vanhatalo, Ermei Mäkilä, Antti J Hakanen, Eveliina Munukka, Jarno Salonen, Timo Saarinen, Juha Grönroos, Suvi Sippola, Paulina Salminen
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引用次数: 0

摘要

目的:阑尾结石与急性阑尾炎更复杂的病程和非手术治疗失败有关。我们旨在更新最初于 1966 年描述的阑尾结石分类,并评估阑尾结石特征与阑尾炎严重程度的关联:这项前瞻性预定义 MAPPAC 试验(ClinicalTrials.gov NCT03257423)子研究纳入了 CT 诊断为阑尾炎并伴有阑尾结石的患者。手术时采集 CT 可见阑尾结石,通过形态学检查并辅以显微 CT 和显微 X 射线荧光光谱进行测量和定性。患者分为两组:无其他并发症的阑尾结石性阑尾炎和伴有并发症(阑尾坏疽、穿孔和/或脓肿)的阑尾结石性阑尾炎。评估了阑尾结石分类和特征与阑尾炎严重程度的关系:结果:在 78 名有 CT 阑尾结石的患者中,收集到 41 块阑尾结石,并根据硬度将其分为三类。最硬的阑尾结石(3 级)较少见(19.5%),表现为外层坚硬如石,内层结构同心分层环绕核心。在第 2 类阑尾石中也能观察到分层的内部结构,但在软的第 1 类阑尾石中则没有。阑尾结石的硬度或尺寸(最大长度、直径和重量)与阑尾炎的严重程度无关。钙和磷等主要无机元素在大多数阑尾结石中的空间分布各不相同:结论:这一更新的分类方法证实了 CT 可见阑尾结石可根据其物理和化学特征分为三类。有关阑尾结石的临床和病理特征的数据很少,采用这种系统分类方法将有助于加深对阑尾结石的了解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Appendicolith classification: physical and chemical properties of appendicoliths in patients with CT diagnosed acute appendicitis - a prospective cohort study.

Objective: Appendicoliths are associated with a more complicated course of acute appendicitis and failure of non-operative treatment. We aimed to update the appendicolith classification originally described in 1966 and to assess the association of appendicolith characteristics with appendicitis severity.

Design: This prospective predefined MAPPAC-trial (ClinicalTrials.gov NCT03257423) substudy included patients with CT diagnosed appendicitis presenting with an appendicolith. CT visible appendicoliths were harvested at surgery, measured and characterised by morphological examination complemented with micro-CT and micro-X-ray fluorescence spectroscopy. Patients were categorised into two groups: appendicolith appendicitis without other complications and appendicolith appendicitis with complications (appendiceal gangrene, perforation and/or abscess). The association of appendicolith classification and characteristics with appendicitis severity was evaluated.

Results: Of 78 patients with a CT appendicolith, 41 appendicoliths were collected and classified based on the degree of hardness into three classes. The hardest appendicoliths (class 3) were less common (19.5%) presenting with a stone-hard outer layer and concentrically layered inner structure around a core. The layered inner structure was also observed in class 2 appendicoliths, but was absent in soft, class 1 appendicoliths. Appendicolith hardness or measures (maximum length, diameter and weight) were not associated with appendicitis severity. The spatial distribution of the main inorganic elements of calcium and phosphorus varied within most appendicoliths.

Conclusion: This updated classification confirms categorisation of CT visible appendicoliths into three classes based on their physical and chemical characteristics. The data on clinical and aetiopathological characteristics of appendicoliths is scarce and using this systematic classification would add to this understanding.

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来源期刊
BMJ Open Gastroenterology
BMJ Open Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.90
自引率
3.20%
发文量
68
审稿时长
2 weeks
期刊介绍: BMJ Open Gastroenterology is an online-only, peer-reviewed, open access gastroenterology journal, dedicated to publishing high-quality medical research from all disciplines and therapeutic areas of gastroenterology. It is the open access companion journal of Gut and is co-owned by the British Society of Gastroenterology. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around continuous publication, publishing research online as soon as the article is ready.
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