急性阑尾炎

为所有患者申请 FBC 检查。[27]Association of Surgeons of Great Britain and Ireland; Royal College of Surgeons of England. Commissioning guide: emergency general surgery (acute abdominal pain). April 2014 [internet publication].https://www.rcseng.ac.uk/library-and-publications/rcs-publications/docs/emergency-general-guide/

利用血液检验结果，并结合病史和体格检查，通过评分系统对患者进行风险分层；分层结果可以确定是否需要影像学检查。[7]Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3http://www.ncbi.nlm.nih.gov/pubmed/32295644?tool=bestpractice.com 请参阅诊断建议章节中的风险分层。

• 80%-90% 的阑尾炎成人患者表现为白细胞增多：（10-18）x 10/L 伴中性粒细胞增多。

• 入院时白细胞增多（≥16 x 10/L）和 CRP 水平升高（≥10 mg/L）是儿童阑尾炎的强预测因素。[7]Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3http://www.ncbi.nlm.nih.gov/pubmed/32295644?tool=bestpractice.com

白细胞增多：成人 （10-18）x 10/L 或 10,000-18,000/μL；儿童 ≥16 x 10/L 或 16,000/μL）

为所有患者申请 CRP 检查。[27]Association of Surgeons of Great Britain and Ireland; Royal College of Surgeons of England. Commissioning guide: emergency general surgery (acute abdominal pain). April 2014 [internet publication].https://www.rcseng.ac.uk/library-and-publications/rcs-publications/docs/emergency-general-guide/

• C 反应蛋白可能会升高。[9]Benabbas R, Hanna M, Shah J, et al. Diagnostic accuracy of history, physical examination, laboratory tests, and point-of-care ultrasound for pediatric acute appendicitis in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2017 May;24(5):523-51.https://onlinelibrary.wiley.com/doi/10.1111/acem.13181http://www.ncbi.nlm.nih.gov/pubmed/28214369?tool=bestpractice.com

• 入院时 CRP 水平升高（≥10 mg/L）和白细胞增多（≥16 x 10/L）是儿童阑尾炎的强预测因素。

对于成人，可利用初步血液检验结果，结合病史和体格检查，通过评分系统对患者进行风险分层；分层结果可以确定是否需要进行影像学检查。[7]Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3http://www.ncbi.nlm.nih.gov/pubmed/32295644?tool=bestpractice.com 请参阅诊断建议章节中的风险分层。

可能呈升高

如果需要影像学检查，请寻求放射科医师意见，以确定适合患者的最佳影像学检查。

如果担心辐射风险，可进行超声检查；应将其用作儿童和孕妇的一线检查。[7]Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3http://www.ncbi.nlm.nih.gov/pubmed/32295644?tool=bestpractice.com[27]Association of Surgeons of Great Britain and Ireland; Royal College of Surgeons of England. Commissioning guide: emergency general surgery (acute abdominal pain). April 2014 [internet publication].https://www.rcseng.ac.uk/library-and-publications/rcs-publications/docs/emergency-general-guide/[52]Bendeck SE, Nino-Murcia M, Berry GJ, et al. Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiology. 2002 Oct;225(1):131-6.http://www.ncbi.nlm.nih.gov/pubmed/12354996?tool=bestpractice.com[53]Bachur RG, Callahan MJ, Monuteaux MC, et al. Integration of ultrasound findings and a clinical score in the diagnostic evaluation of pediatric appendicitis. J Pediatr. 2015 May;166(5):1134-9.http://www.ncbi.nlm.nih.gov/pubmed/25708690?tool=bestpractice.com 这是一项快速检查，可在床旁进行。[7]Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3http://www.ncbi.nlm.nih.gov/pubmed/32295644?tool=bestpractice.com​ 查阅当地常规，因为各指南在超声使用方面的建议有所不同。

• 如果可见全长的正常阑尾，则可以排除急性阑尾炎。[7]Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3http://www.ncbi.nlm.nih.gov/pubmed/32295644?tool=bestpractice.com[30]American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Appendicitis, Diercks DB, Adkins EJ, et al. Clinical policy: critical issues in the evaluation and management of emergency department patients with suspected appendicitis: approved by ACEP Board of Directors February 1, 2023. Ann Emerg Med. 2023 Jun;81(6):e115-52.https://www.annemergmed.com/article/S0196-0644(23)00029-X/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/37210169?tool=bestpractice.com

• 超声还可用于检测腹痛的其他原因（例如妇科疾病）。[7]Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3http://www.ncbi.nlm.nih.gov/pubmed/32295644?tool=bestpractice.com[27]Association of Surgeons of Great Britain and Ireland; Royal College of Surgeons of England. Commissioning guide: emergency general surgery (acute abdominal pain). April 2014 [internet publication].https://www.rcseng.ac.uk/library-and-publications/rcs-publications/docs/emergency-general-guide/

超声检查无法明确诊断时可为孕妇安排 MRI。[7]Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3http://www.ncbi.nlm.nih.gov/pubmed/32295644?tool=bestpractice.com[54]Basaran A, Basaran M. Diagnosis of acute appendicitis during pregnancy: a systematic review. Obstet Gynecol Surv. 2009 Jul;64(7):481-8.http://www.ncbi.nlm.nih.gov/pubmed/19545456?tool=bestpractice.com

外径>6 mm 的无蠕动或者不塌陷的管状结构

如果需要影像学检查，请寻求放射科医师意见，以确定适合患者的最佳影像学检查。

对于以下情况，可考虑增强 CT 扫描：[7]Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3http://www.ncbi.nlm.nih.gov/pubmed/32295644?tool=bestpractice.com

• 超声无法明确诊断，临床仍怀疑为阑尾炎[7]Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3http://www.ncbi.nlm.nih.gov/pubmed/32295644?tool=bestpractice.com

  • 对于儿童，如果诊断存疑且超声检查结果不确定，可根据当地医疗资源和专业能力，进行 CT 或 MRI 检查。[7]Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3http://www.ncbi.nlm.nih.gov/pubmed/32295644?tool=bestpractice.com

  • 如果超声阴性，则首选低剂量 CT。[7]Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3http://www.ncbi.nlm.nih.gov/pubmed/32295644?tool=bestpractice.com

• 您怀疑恶性肿瘤[7]Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3http://www.ncbi.nlm.nih.gov/pubmed/32295644?tool=bestpractice.com

• 您怀疑阑尾肿块或脓肿。[7]Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3http://www.ncbi.nlm.nih.gov/pubmed/32295644?tool=bestpractice.com

静脉造影剂增强 CT 扫描（联合或不联合使用口服造影剂）的敏感性高达 100%，相比而言，非静脉、造影剂增强 CT 扫描的敏感性为 92%。[61]Hlibczuk V, Dattaro JA, Jin Z, et al. Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review. Ann Emerg Med. 2010 Jan;55(1):51-9.http://www.ncbi.nlm.nih.gov/pubmed/19733421?tool=bestpractice.com[63]Arruzza E, Milanese S, Li LSK, et al. Diagnostic accuracy of computed tomography and ultrasound for the diagnosis of acute appendicitis: a systematic review and meta-analysis. Radiography (Lond). 2022 Nov;28(4):1127-41.http://www.ncbi.nlm.nih.gov/pubmed/36130469?tool=bestpractice.com[74]Chiu YH, Chen JD, Wang SH, et al. Whether intravenous contrast is necessary for CT diagnosis of acute appendicitis in adult ED patients? Acad Radiol. 2013 Jan;20(1):73-8.https://www.academicradiology.org/article/S1076-6332(12)00385-6/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/22951113?tool=bestpractice.com

[Figure caption and citation for the preceding image starts]: 腹部 CT：增厚的阑尾Nasim Ahmed, MBBS, FACS；经许可后使用 [Citation ends].​​

异常阑尾（直径>6 mm）可被检出，或者可见阑尾周围炎症伴阑尾内钙化结石

行尿液分析有助于排除泌尿道感染（urinary tract infection, UTI）。[25]Lewis SR, Mahony PJ, Simpson J. Appendicitis. BMJ. 2011 Oct 6;343:d5976.http://www.ncbi.nlm.nih.gov/pubmed/21980077?tool=bestpractice.com

• UTI 可出现与阑尾炎非常相似的症状和征象。

• 请勿仅凭尿液分析来确定 UTI 的诊断。还需结合泌尿症状史以及尿显微镜检查结果来判断。

请注意，约 50% 急性阑尾炎患者的尿液分析结果可能异常，这是因为右侧泌尿道和膀胱附近有炎症。[65]Yamamoto M, Ando T, Kanai S, et al. Abnormal urinalysis in acute appendicitis. Hinyokika Kiyo. 1985 Oct;31(10):1723-5.https://repository.kulib.kyoto-u.ac.jp/dspace/bitstream/2433/118636/1/31_1723.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/4091121?tool=bestpractice.com

如果尿液分析示红细胞、白细胞或亚硝酸盐阳性，应考虑肾绞痛或 UTI 等其他诊断。

所有育龄女性均应行此项检测，以排除妊娠，包括异位妊娠。[66]Gray J, Wardrope J, Fothergill DJ. 7 Abdominal pain, abdominal pain in women, complications of pregnancy and labour. Emerg Med J. 2004 Sep;21(5):606-13.http://www.ncbi.nlm.nih.gov/pubmed/15333547?tool=bestpractice.com

妊娠时阳性

考虑对手术患者进行血型鉴定配对及备血。[27]Association of Surgeons of Great Britain and Ireland; Royal College of Surgeons of England. Commissioning guide: emergency general surgery (acute abdominal pain). April 2014 [internet publication].https://www.rcseng.ac.uk/library-and-publications/rcs-publications/docs/emergency-general-guide/

供手术室使用

如果需要影像学检查，请寻求放射科医师意见，以确定适合患者的最佳影像学检查。

超声检查无法明确诊断时可为孕妇安排 MRI。[7]Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3http://www.ncbi.nlm.nih.gov/pubmed/32295644?tool=bestpractice.com

对于儿童，如果诊断存疑且超声检查结果不确定，可根据当地医疗资源和专业能力，进行 MRI 或 CT 检查。[7]Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3http://www.ncbi.nlm.nih.gov/pubmed/32295644?tool=bestpractice.com

发现异常阑尾（外径 >6 mm），以及阑尾周围炎性改变证据，阑尾结石，脂肪条束征

研究显示，外周血中嗜中性粒细胞和淋巴细胞的简单比值对急性阑尾炎有一定的预测能力，可能作为诊断的有用辅助工具。[67]Eun S, Ho IG, Bae GE, et al. Neutrophil-to-lymphocyte ratio for the diagnosis of pediatric acute appendicitis: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2021 Nov;25(22):7097-7107.https://www.europeanreview.org/article/27263http://www.ncbi.nlm.nih.gov/pubmed/34859875?tool=bestpractice.com[75]Hajibandeh S, Hajibandeh S, Hobbs N, et al. Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: a systematic review and meta-analysis. Am J Surg. 2020 Jan;219(1):154-63.http://www.ncbi.nlm.nih.gov/pubmed/31056211?tool=bestpractice.com

中性粒细胞-淋巴细胞比例升高（>4.7）

多项研究表明，低钠血症与急性阑尾炎之间存在关联，是复杂性阑尾炎的一个预测指标。[68]Giannis D, Matenoglou E, Moris D. Hyponatremia as a marker of complicated appendicitis: a systematic review. Surgeon. 2020 Oct;18(5):295-304.http://www.ncbi.nlm.nih.gov/pubmed/32035730?tool=bestpractice.com[69]Zhan W, Deng W, Liu Y, et al. Hyponatremia as a predictor of complicated appendicitis in children: a systematic review and meta-analysis. Asian J Surg. 2022 Oct;45(10):2009-11.https://www.sciencedirect.com/science/article/pii/S1015958422004493?via%3Dihubhttp://www.ncbi.nlm.nih.gov/pubmed/35490069?tool=bestpractice.com

低钠血症

五聚蛋白-3 是一种急性期蛋白，在急性阑尾炎时可能升高。[70]Anand S, Pakkasjärvi N, Bajpai M, et al. Utility of Pentraxin-3 as a biomarker for diagnosis of acute appendicitis: a systematic review and meta-analysis. Pediatr Surg Int. 2022 Aug;38(8):1105-12.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9259520/http://www.ncbi.nlm.nih.gov/pubmed/35704081?tool=bestpractice.com

五聚蛋白-3 水平升高

一项系统回顾和荟萃分析显示，血清淀粉样蛋白 A 在识别急性阑尾炎方面的灵敏性和特异性分别为 0.87 和 0.74。[71]Shi W, Wu Y, Zhong L, et al. Diagnostic accuracy of serum amyloid A in acute appendicitis: a systematic review and meta-analysis. Surg Infect (Larchmt). 2022 May;23(4):380-7.http://www.ncbi.nlm.nih.gov/pubmed/35319305?tool=bestpractice.com

血清淀粉样蛋白 A 升高

研究表明，血小板平均体积低是急性阑尾炎的一种指标。[72]Tullavardhana T, Sanguanlosit S, Chartkitchareon A. Role of platelet indices as a biomarker for the diagnosis of acute appendicitis and as a predictor of complicated appendicitis: a meta-analysis. Ann Med Surg (Lond). 2021 Jun;66:102448.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8181186/http://www.ncbi.nlm.nih.gov/pubmed/34136215?tool=bestpractice.com[73]Shen G, Li S, Shao Z, et al. Platelet indices in patients with acute appendicitis: a systematic review with meta-analysis. Updates Surg. 2021 Aug;73(4):1327-41.http://www.ncbi.nlm.nih.gov/pubmed/33439467?tool=bestpractice.com

平均血小板体积低