بررسي رابطه پرفوريشن آپانديس و تأخير در تشخيص آپانديسيت حاد در بيمارستان شهيد بهشتي كاشان طي سال¬هاي 1391-1389

The Relationship between the Delay in the Diagnosis of Acute Appendicitis and the Risk of Perforation: A Study at Shahid Beheshti Hospital of Kashan, 2010 -2012

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺍﺭﺗﺒﺎﻁ ﺑﻴﻦ ﺗﺄﺧﻴﺮ ﺩﺭ ﺗﺸﺨﻴﺺ ﺁﭘﺎﻧﺪﻳﺴﻴﺖ ﺣﺎﺩ ﻭ ﺧﻄﺮ ﺍﻳﺠﺎﺩ ﭘﺮﻓﻮﺭﺍﺳﻴﻮﻥ ﺁﭘﺎﻧﺪﻳﺲ ﻫﻨﻮﺯ ﺑﻪ ﺭﻭﺷﻨﻲ ﻣﺸﺨﺺ ﻧﻴﺴﺖ. ﻫﺪﻑ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺮﺭﺳﻲ ﺑﻴ ﻤﺎﺭﺍﻥ ﺁﭘﺎﻧﺪﮐﺘﻮﻣﻲ ﺷﺪﻩ ﺍﺯ ﻧﻈﺮ ﺗﻌﻴﻴﻦ ﻓﺮﺍﻭﺍﻧﻲ ﺁﭘﺎﻧﺪﻳﺴﻴﺖ ﭘﺮﻓﻮﺭﻩ ﺩﺭ ﻣﻴﺎﻥ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎ ﺗﺄﺧﻴﺮ ﺩﺭ ﺗﺸﺨﻴﺺ ﺁﭘﺎﻧﺪﻳﺴﻴﺖ ﻣﻲﺑﺎﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﭘـﺮﻭﻧﺪﻩ 508 ﻧﻔﺮ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻧﻲ ﮐﻪ ﺩﺭ ﺳﺎﻝﻫﺎﻱ 1389 -1391 ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘـﺎﻥ ﺷﻬﻴـﺪ ﺑﻬﺸﺘـﻲ ﮐﺎﺷـﺎﻥ ﺗﺤﺖ ﻋﻤﻞ ﺁﭘﺎﻧﺪﮐﺘـﻮﻣﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ، ﻣـ ﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗـﺮﺍﺭ ﮔـﺮﻓﺖ ﻭ ﺳﻦ، ﺟﻨﺲ، ﻧﻮﻉ ﺁﭘﺎﻧﺪﻳﺴﻴﺖ ﻭ ﻣـﺪﺕ ﺯﻣﺎﻧﻲ ﮐﻪ ﺑﻴﻤـﺎﺭ ﻗﺒﻞ ﺍﺯ ﻋﻤـﻞ ﺁﭘﺎﻧﺪﮐﺘﻮﻣﻲ ﻋﻼﻣﺖﺩﺍﺭ ﺑﻮﺩﻩ ﺍﺳﺖ، ﺛﺒـﺖ ﺷﺪ. ﺩﺭ ﻧﻬﺎﻳﺖ ﺩﺍﺩﻩﻫﺎﻱ ﺑﻪ ﺩﺳﺖ ﺁﻣـﺪﻩ ﻭﺍﺭﺩ ﻧﺮﻡ ﺍﻓـﺰﺍﺭ 16 SPSS ﺷـﺪﻩ ﻭ ﺑﺎ ﺁﺯﻣـﻮﻥ ﺁﻣـﺎﺭﻱ ﻓﻴﺸﺮ ﻭ ﮐﺎﯼ ﺍﺳﮑﻮﺍﺭ ﻣﻮﺭﺩ ﺗﺠﺰﻳﻪ ﻭ ﺗﺤﻠﻴﻞ ﻗﺮﺍﺭ ﮔﺮﻓﺖ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺍﺯ 508 ﺑﻴﻤـﺎﺭ ﻣﻮﺭﺩ ﺑـﺮﺭﺳﻲ 128 ﺑﻴﻤـﺎﺭ ﺁﭘﺎﻧـﺪﻳﺴﻴﺖ ﭘﺮﻓـﻮﺭﻩ ﺩﺍﺷﺘﻨﺪ. ﻣﻴـﺰﺍﻥ ﭘﺮﻓـﻮﺭﺍﺳﻴﻮﻥ ﺩﺭ ﮔـﺮﻭﻩ ﺑﺪﻭﻥ ﺗﺄﺧﻴـﺮ ﺩﺭ ﺗﺸﺨﻴـﺺ ﺁﭘﺎﻧﺪﻳﺴﻴـﺖ 28/9 ﻭ ﺩﺭ ﮔـﺮﻭﻩ ﺑﺎ ﺗﺄﺧﻴـﺮ ﺩﺭ ﺗﺸﺨﻴـﺺ ﺁﭘﺎﻧـﺪﻳﺴﻴﺖ 14/1 ﺑـﻮﺩ ﮐﻪ ﺍﺯ ﻧﻈﺮ ﺁﻣﺎﺭﻱ ﺍﻳﻦ ﺍﺧﺘﻼﻑ ﻣﻌﻨﺎﺩﺍﺭ ﺑﻮﺩP value<0.005 (. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺍﮔﺮﭼﻪ ﺗﺸﺨﻴﺺ ﺁﭘﺎﻧﺪﻳﺴﻴﺖ ﺑﻪ ﻋﻠﺖ ﺗﺸﺨﻴـﺺ ﺍﻓﺘـﺮﺍﻗﻲﻫﺎﻱ ﻭﺳﻴﻊ ﺑﺴﻴﺎﺭ ﺩﺷـﻮﺍﺭ ﻭ ﺯﻣﺎﻥ ﺑﺮ ﺍﺳﺖ، ﺍﻣﺎ ﺗﺄﺧﻴﺮ ﺩﺭ ﺗﺸﺨﻴﺺ ﺁﭘﺎﻧﺪﻳﺴﻴﺖ ﺣﺎﺩ ﻧمي ﺗﻮﺍﻧﺪ ﺑﻪ ﺗﻨﻬﺎﻳﻲ ﺗﻮﺟﻴﻪﮐﻨﻨﺪﻩ ﻣـﻮﺍﺭﺩ ﭘﺮﻓﻮﺭﻩ ﺁﭘﺎﻧﺪﻳﺴﻴﺖ ﺑﺎﺷﺪ. ﺍﻧﺠـﺎﻡ ﻣﻄﺎﻟﻌـﺎﺕ ﺑﻴﺸﺘﺮ ﺑﺮﺍﻱ ﺍﺛﺒﺎﺕ ﺍﻳﻦ ﺍﺩﻋﺎ ﻣﻮﺭﺩ ﻧﻴﺎﺯ ﺍﺳﺖ.

Introduction & Objective: The relationship between the delay in the diagnosis of acute appendicitis and the risk of perforation is not clear yet. The aim of this study is the reviewing of appendectomy cases in order to determine the incidence of perforation due to the delay in the diagnosis. Materials & Methods: Records of 508 patients who were operated on for acute appendicitis between years 2010-2012 in Shahid Beheshti hospital of Kashan were reviewed. Data gathered included age at the time of operation, gender, kind of appendicitis, duration of symptoms before diagnosis. Finally, the obtained data were entered into SPSS 16 software and were analyzed by using chi square, Fisher's exact test. Results: Out of 508 patients, 128(25.2%) had perforated appendicitis. The perforation rate in patients without diagnostic delay was 28.9%, and in patients with diagnostic delay was 14.1%. This difference was statistically significant (P-value<0.005). Conclusions: Although appendicitis is hard to diagnose, because of a wide differential diagnosis, this diagnostic delay is not the role reason for perforation. Further studies are needed to confirm this result.