| Background and Objective:Acute appendicitis is the most common cause of surgical acute abdomen,accounting for approximately 25% of cases.In recent years,the incidence of acute appendicitis has increased due to changes in lifestyle and dietary habits,making it a significant health concern that impacts quality of life.Laparoscopic appendectomy has emerged as the preferred treatment for acute appendicitis.Compared with traditional open appendectomy,laparoscopic appendectomy has the advantages of safety and reliability,less trauma,less bleeding,rapid recovery,light postoperative pain,and no obvious surgical scar,but it is limited by the limitations of laparoscopic instruments,the degree of adhesion between the appendix and surrounding tissues,and abnormal anatomical relationship,Some patients with laparoscopic appendectomy need to undergo conversion to open surgery,which leads to the problem of prolonged operation time and frequent complications.Therefore,reasonable use of relatively simple preoperative evaluation means to select a reasonable treatment plan in advance is crucial to solve the above problems.CT examination can directly and real-time display the relationship between the appendix and its surrounding tissues,and can effectively use some indicators of preoperative CT examination to comprehensively evaluate various risk factors,so as to predict the difficulty of laparoscopic appendectomy before surgery,which can guide clinical work to a certain extent,minimize the risk of surgery,and ensure the safety of patients.The purpose of this paper is to predict the difficulty of emergency laparoscopic appendectomy through preoperative CT related indicators,and guide clinical work.Methods:Collect data on patients who underwent laparoscopic appendectomy for acute appendicitis in the emergency department of our hospital between October 2020 and October 2022.Divide these patients into two groups based on the difficulty of the laparoscopic appendectomy procedure: an easy group and a difficult group.Collect the following data from each patient’s preoperative CT scan: appendix diameter,appendix wall thickness,the presence and location of appendix feces,the relationship between the appendix and surrounding tissues,and the position of the appendix.Analyze the collected data statistically and compare the differences between the easy and difficult groups using a significance level of P < 0.05.Results:This study collected a total of 201 eligible patients who successfully underwent laparoscopic appendectomy in our hospital,and collected the preoperative CT appendix indexes of patients,including the minimum diameter of appendix,the thickness of appendix wall,the presence and location of appendix feces,the location of appendix,and the relationship between appendix and surrounding tissues.Single factor analysis showed that the minimum diameter of the appendix>10mm,the thickness of the appendix wall>3mm,the fecal stone in the appendix lumen,and the periappendiceal exudation(P.We use the characteristics of logistic regression analysis,take the above risk factors(X)as the independent variable,take the difficulty of LA surgery(Y)as the dependent variable,and use the regression coefficient of each risk factor to assign the above risk factors respectively,and establish the function Y=β0+β1X1+β2X2+β3X3+、、、+βi Xi(the value assigned is 1 when the risk factor exists and 0 when it does not exist)=-7.297+2.505 × Minimum diameter of appendix(1for appendix diameter > 10 mm,0 for ≤ 10mm)+4.926 × Tissue relationship around the appendix(0 for no obvious blur around the appendix,0.5 for exudative blur,1 for exudative effusion or ileocecal thickening)+2.078×Whether there is appendix fecal stone(0 for appendix without fecal stone,1 for appendix fecal stone 1 cm outside the root,and 1.8 for appendix fecal stone 1 cm inside the root).In order to facilitate clinical application,we simplified some numbers and calculated the comprehensive score of each patient.Compared with the actual operation difficulty,we used the ROC curve to verify the prediction efficiency,and obtained that the ROC curve of preoperative CT scoring system to predict the difficulty of LA surgery is above the reference line,the area under the AUC curve is 0.945,the standard error is 0.016,the P value is less than 0.001,and the 95% confidence interval is 0.913-0.976.Compared with the AUC(0.5)obtained under complete randomization,the P value is less than 0.05,and the difference is significant.It is confirmed that the preoperative CT scoring system can preliminarily predict the actual difficulty of LA surgery,and the scoring system has relatively satisfactory accuracy.The Yoden index is 0.768.When the best threshold is 6.5,the sensitivity and specificity are 0.890 and 0.878.Therefore,combining with the ROC curve,we can know that when the preoperative CT score prediction model score is greater than or equal to 6.5 points,we can judge that the patient’s LA surgery is difficult and belongs to the difficult group,and the patient below 6.5 points belongs to the easy group.Conclusions:1.According to the multivariate logistic regression analysis and its characteristics,it is suggested that the minimum diameter of appendix>10mm,the fecal stone in the appendix lumen,and the exudation around the appendix are independent risk factors affecting the difficulty of LA surgery.2.Preoperative CT can preliminarily predict the difficulty of LA surgery.According to the analysis of ROC results,when the preoperative CT prediction model score is greater than or equal to 6.5 points,it can be judged that the patient has a high difficulty in LA surgery,which is a difficult group,and less than 6.5 points is an easy group.The preoperative CT can guide the clinical work.3.Preoperative CT can initially guide clinical work.For patients with high difficulty in preoperative evaluation of LA,we should select a highly qualified doctor with rich experience in laparoscopic technology to complete the operation,so as to minimize perioperative complications and ensure patient safety. |
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