| Objective:Through the analysis of clinical data of patients admitted with periappendiceal abscess for diagnosis,to explore how to effectively distinguish patients with appendiceal tumor mixed with patients with periappendiceal abscess,so as to reduce the effect of misdiagnosis and missed diagnosis rate.At the same time,it provides reference for the choice of treatment for patients with appendiceal tumor.Methods:A retrospective analysis was performed on 387 patients diagnosed with periappendicular abscess admitted to the Second Hospital of Dalian Medical University from January 2012 to December 2022,who were included in this clinical study.The patient’s clinical data included serological examination such as leukocyte,neutrophil percentage,hemoglobin,tumor markers,imaging findings such as ultrasound and CT,surgical procedures,postoperative pathological findings,and prognosis.Statistical analysis was performed by SPSS 26.0 software.Normality test and homogeneity test of variance were conducted on the data,which were consistent with normal distribution and homogeneity of variance.Measurement data conforming to normal distribution were described in the form of "mean ± standard deviation" and independent sample t test was used.If not,use nonparametric rank sum test.Count data were expressed as rate(%)using χ~2 test or Fisher’s exact test.The percentage is expressed as a percentage(%).Kaplan-Meier method was used to calculate the survival rate and draw the survival curve.All test levels were α=0.05,and P<0.05 was considered statistically significant.Results:There was no significant difference in gender between appendiceal tumor and periappendiceal abscess.The mean age of patients in the periappendiceal abscess group was 48.51±19.07 years old,and the mean age of patients in the appendiceal tumor group was 60.66± 14.02 years old.The mean age of patients in the periappendiceal abscess group was significantly lower than that in the appendiceal tumor group.The proportion of patients admitted to hospital with abdominal pain as the first symptom in the periappendiceal abscess group was significantly higher than that in the appendiceal tumor group,and the difference was statistically significant.The average level of white blood cell count,neutrophil percentage and hemoglobin was 12.653±4.572(×109/L),79.202±8.758(%)and 132.334±17.554(g/L)in patients with periappendiceal abscess.The average level of leukocyte count,neutrophil percentage and hemoglobin was 9.081±4.940(×109/L),72.951±14.013(%)and 129.657±21.117(g/L)in patients with appendiceal tumor group.In this study,the proportion of patients with elevated leukocyte count and neutrophil percentage in patients with periappendiceal abscess was significantly higher than that in patients with appendiceal tumor,and the difference was statistically significant(76.4%>37.1%;73.6%>48.6%).However,changes in hemoglobin levels did not significantly reflect the difference between patients with periappendiceal abscess and appendiceal tumor.110 patients in the periappendiceal abscess group had abnormal tumor markers,and 20 patients in the appendiceal tumor group had abnormal tumor markers.The proportion of patients with abnormal tumor markers in appendiceal tumor group was significantly higher than that in periappendiceal abscess group,and the difference was statistically significant(57.1%>31.3%).There were 288 patients in the periappendiceal abscess group and 20 patients in the appendiceal tumor group admitted to the hospital for ultrasound examination,among which 194 patients and 14 patients showed mixed mass in the right lower abdomen,respectively.There was no statistically significant difference in ultrasound results between the periappendiceal abscess group and the appendiceal tumor group.279 cases of patients in the periappendiceal abscess group and 28 cases of patients in the appendiceal tumor group were admitted to the hospital for plain CT examination,among which 156 cases and 15 cases showed appendiceal thickening,respectively.Peripheral lymph node shadow was observed in 165 cases and 15 cases,respectively.Soft tissue mass shadows were observed in 24 cases and 9 cases,respectively.There were 8 cases and 5 cases indicating cystic dilatation of appendix,respectively.There were 37 cases and 4 cases without obvious abnormality.Among them,there was no significant difference in imaging findings between appendiceal thickening and peripheral lymph node shadow and no obvious abnormality.The incidence of soft tissue mass shadow and appendiceal cystic dilatation in the appendiceal tumor group was significantly higher than that in the periappendiceal abscess group(32.1%>8.6%;17.9%>2.9%),the difference was statistically significant.Among the 35 patients with appendiceal tumor,13 had appendectomy,19 had right hemicolectomy,2 had partial tumor reduction surgery,and 1 had exploratory laparotomy only.The end of follow-up in this clinical study was December 31,2022.Of the 32 patients who underwent complete appendectomy,17 were followed for 3-129 months,median follow-up for 72.0 months(95%CI:31.578-112.422),and 15 were lost to follow-up.Univariate analysis showed that there was a statistical difference between right hemicolectomy and appendectomy alone on survival.Conclusions:1.The patients admitted with periappendicular abscess are older(>50 years old),the first symptom is not abdominal pain,the percentage of white blood cells and neutrophils is not increased according to blood routine,the tumor markers are abnormal,and the CT examination suggests soft tissue mass or cystic dilatation of the appendix.2.When determining tumor diagnosis,appropriate surgical treatment and postoperative chemotherapy should be selected according to tumor type and stage,which can effectively improve the survival rate of patients. |
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