ﺗﺮﯾﺎد ﺑﺎﻟﯿﻨﯽ ﺳﺎده و دﻗﯿﻖ در ﺗﺸﺨﯿﺺ آﭘﺎﻧﺪﯾﺴﯿﺖ ﺣﺎد

A Simple and Accurate Clinical Triad of Acute Appendicitis

زﻣﯿﻨﻪ و ﻫﺪف: آﭘﺎﻧﺪﯾﺴﯿﺖ ﺷﺎﯾﻌﺘﺮﯾﻦ ﻋﻤﻞ ﺟﺮاﺣﯽ ﻋﻤﻮﻣﯽ ﻣﯽﺑﺎﺷﺪ و ﻣﻬﻤﺘﺮﯾﻦ روش ﺗﺸﺨﯿﺼﯽ آن ﺑﺎﻟﯿﻨﯽ اﺳﺖ. ﺗﺸﺨﯿﺺ زود ﻫﻨﮕﺎم و اﻗﺪام ﺑﻪ ﻣﻮﻗﻊ ﺟﺮاﺣﯽ ﻣﻨﺠﺮ ﺑﻪ ﮐﺎﻫﺶ ﭼﺸﻤﮕﯿﺮ ﻋﻮارض ﺧﻮاﻫﺪ ﺷﺪ. ﻫﺪف از ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺮرﺳﯽ ﺻﺤﺖ و دﻗﺖ ﮐﺮاﯾﺘﺮﯾﺎي ﺑﺎﻟﯿﻨﯽ درد ﺷﮑﻢ، ﺣﺴﺎﺳﯿﺖ در ﻟﻤﺲ و ﻣﻬﺎﺟﺮت درد در ﺗﺸﺨﯿﺺ آﭘﺎﻧﺪﯾﺴﯿﺖ ﺣﺎد اﺳﺖ. ﻣﻮاد و روش ﻫﺎ: در ﯾﮏ ﻣﻄﺎﻟﻌﻪ ﻣﻘﻄﻌﯽ ﺗﻤﺎم ﺑﯿﻤﺎراﻧﯽ ﮐﻪ ﻣﺸﮑﻮك ﺑﻪ آﭘﺎﻧﺪﯾﺴﯿﺖ ﺑﻮده و ﺗﻮﺳﻂ ﯾﮏ ﺟﺮاح ﺑﺮرﺳﯽ و ﺟﺮاﺣﯽ ﺷﺪهاﻧﺪ، وارد ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ. ﻣﻌﯿﺎر ﺟﺮاح ﺟﻬﺖ ﺗﺼﻤﯿﻢﮔﯿﺮي ﺑﺮاي ﺟﺮاﺣﯽ ﻓﻘﻂ ﻋﻼﯾﻢ ﺑﺎﻟﯿﻨﯽ ﺑﻮده اﺳﺖ. دادهﻫﺎ ﺑﺎ ﻧﺮم اﻓﺰار 20 SPSS و ﺑﺎ اﺳﺘﻔﺎده از ﺗﺴﺖ آﻣﺎري ﮐﺎي اﺳﮑﻮار ﻣﻮرد ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: از 127 ﺑﯿﻤﺎر ﻣﻮرد ﻣﻄﺎﻟﻌﻪ 109 ﺑﯿﻤﺎر )85/8%( ﺗﺮﯾﺎد درد ﺷﮑﻢ ﺣﺴﺎﺳﯿﺖ ﻣﻮﺿﻌﯽ رﺑﻊ ﺗﺤﺘﺎﻧﯽ راﺳﺖ ﺷﮑﻢ )RLQ( و ﻣﻬﺎﺟﺮت درد، و 18 ﺑﯿﻤﺎر )14/2%( درد ﺷﮑﻢ و ﺣﺴﺎﺳﯿﺖ ﻣﻮﺿﻌﯽ رﺑﻊ ﺗﺤﺘﺎﻧﯽ راﺳﺖ ﺷﮑﻢ داﺷﺘﻨﺪ. ﻣﯿﺰان ﻧﺮﻣﺎل آﭘﺎﻧﺪﮐﺘﻮﻣﯽ 17 ﻣﻮرد )13/4%( ﺑﻮد. ﺑﺮ اﺳﺎس ﮔﺰارش آﺳﯿﺐ ﺷﻨﺎﺳﯽ ﺑﺎﻓﺘﯽ از )109 (%85/8 ﺑﯿﻤﺎري ﮐﻪ ﺗﺮﯾﺎد ﻣﺜﺒﺖ ﺑﻮدﻧﺪ )89/1%( 98 ﺑﯿﻤﺎر آﭘﺎﻧﺪﯾﺴﯿﺖ داﺷﺘﻨﺪ ﺑﺎ ﺣﺴﺎﺳﯿﺖ 89/1% دﻗﺖ 81/9% ارزش اﺧﺒﺎري ﻣﺜﺒﺖ 89/91% وO/R ﻣﻌﺎدل 4/45% )ﻓﺎﺻﻠﻪ اﻃﻤﯿﻨﺎن 95% ﺑﯿﻦ .(1/395 -14/229 ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﺑﺮ اﺳﺎس ﯾﺎﻓﺘﻪﻫﺎي ﭘﮋوﻫﺶ ﺣﺎﺿﺮ، درد ﺷﮑﻢ، ﺣﺴﺎﺳﯿﺖ ﻣﻮﺿﻌﯽ رﺑﻊ ﺗﺤﺘﺎﻧﯽ راﺳﺖ ﺷﮑﻢ و ﻣﻬﺎﺟﺮت درد ﺑﻬﺘﺮﯾﻦ ﻋﻼﯾﻢ دال ﺑﺮ آﭘﺎﻧﺪﯾﺴﯿﺖ ﻫﺴﺘﻨﺪ و ﺻﺮﻓﺎً ﺑﺎ وﺟﻮد اﯾﻦ ﻋﻼﯾﻢ ﻣﯽﺷﻮد، ﺑﯿﻤﺎر را ﮐﺎﻧﺪﯾﺪ ﺟﺮاﺣﯽ آﭘﺎﻧﺪﮐﺘﻮﻣﯽ ﮐﺮد.

Introduction & Objective: Appendicitis is one of the most common operations in general surgery. The best way of diagnosis based on clinical view. Early diagnosis and operation on time reduce complications obviously. In this study the best clinical view of appendicitis investigated and recommended. Materials & Methods: In a cross sectional study all patients suspected to appendicitis that referred to emergency department of Nekui-Hedayati hospital of Qom and managed with one surgeon included to study. Decision making for diagnosis and operation based on clinical symptoms and signs. Data was analyzed with chi-square test in SPSS 20. Results: Of 127 patients 109 p. (85.8%) had clinical triad of abdominal pain, shifting pain to RLQ and RLQ tenderness. Normal appendectomy was 13.4%. on the base of pathology of 109 p. with clinical triad 98 p. (89.1%) had appendicitis with sensitivity of 89.1% , accuracy of 81.9% , positive predictive value of 89.91% and odd ratio of 4.45% (Confidence Interval 95% = 1.395 – 14.229). Conclusions: Clinical triad of abdominal pain, shifting pain to RLQ and RLQ tenderness is the best clinical view of appendicitis and can done operation without any delayed time.