Ulus Travma Acil Cerrahi Derg. 2010; 16(3): 248-252

Akut apandisit tanýsýyla laparotomi uygulanan hastalarda ultrasonografi bulgularý ve lökosit sayýsýnýn deðerlendirilmesi

Ahmet Demircan¹, Gülbin Aygencel¹, Mehmet Karamercan¹, Mehmet Ergin¹, Tonguç Utku Yýlmaz², Ahmet Karamercan^2
1Gazi Üniversitesi Týp Fakültesi Acil Týp Ana Bilim Dalý, Ankara, Türkiye
²Gazi Üniversitesi Týp Fakültesi Genel Cerrahi Ana Bilim Dalý, Ankara, Türkiye

AMAÇ
Akut apandisit (AA) cerrahi gerektiren hastalýklar arasýnda en sýk rastlanan patolojilerden biridir. Tipik olgularda tanýsý kolaydýr, atipik olgularda tanýsý son derece zordur. Bu çalýþmada AA ön tanýsý ile izlenen hastalarda ultrasonografi (USG) bulgularý ve lökosit sayýsý incelendi ve AA tanýsýndaki deðerleri belirlenmeye çalýþýldý.
GEREÇ VE YÖNTEM
2006 yýlýnýn ilk 6 ayýnda AA ön tanýsý ile laparatomiye alýnan 85 hastanýn verileri retrospektif olarak incelendi. Histopatolojik taný (akut apandisit) ile lökosit sayýsý ve USG bulgularý karþýlaþtýrýldý; tanýdaki duyarlýlýklar ortaya konulmaya çalýþýldý.
BULGULAR
Hastalarýn yaþ ortalamasý 33,5 yýl ve %44,7’si kadýndý. Hastalarýn %95,3’ünde lökosit sayýsý 10000/mm³ ve üstündeydi. Hastalarýn %74,1’inde (n=63) USG yapýlmýþ ve %58,7’sinde (n=37) AA ile uyumlu rapor edilmiþtir. Histopatolojik olarak 4 hastada (%4,7) AA lehine bulgu yoktur (negatif laparatomi). Histopatolojik tanýya göre lökosit sayýsýnýn (≥10000/ mm³) AA tanýsýný belirlemedeki duyarlýlýðý %98,77 ve seçiciliði %75’dir. USG’nin tanýdaki duyarlýlýðý %61,02 ve seçiciliði %75’dir. ROC eðrisi altýnda kalan alanlar karþýlaþtýrýldýðýnda lökosit sayýsýnýn tanýyý belirlemede daha duyarlý olduðu görülmüþtür.
SONUÇ
Bu çalýþmada USG’nin duyarlýlýðý literatürde bildirilen yüksek duyarlýlýk oranlarýna göre düþük bulunmuþtur. Lökosit sayýsýnýn duyarlýlýðý ise USG’ye göre daha yüksek bulunmuþtur.

Anahtar Kelimeler: Akut apandisit, duyarlýlýk; lökosit sayýsý; ultrasonografi.

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Ultrasonographic findings and evaluation of white blood cell counts in patients undergoing laparotomy with the diagnosis of acute appendicitis

Ahmet Demircan¹, Gülbin Aygencel¹, Mehmet Karamercan¹, Mehmet Ergin¹, Tonguç Utku Yýlmaz², Ahmet Karamercan^2
1Department Of Emergency Medicine, Gazi University, Ankara, Turkey
²Department Of General Surgery, Gazi University, Ankara, Turkey

BACKGROUND
Acute appendicitis (AA) is one of the most frequent pathologies among surgical illnesses. Diagnosis is easy in typical cases, but difficult in atypical cases. In this study, ultrasonographic (USG) findings and leukocyte counts of patients were examined to determine their values in the diagnosis of AA.
METHODS
Data for 85 patients seen in the first six months of 2006 were examined retrospectively. Histopathological diagnosis together with leukocyte counts and USG findings were compared, and sensitivities in the diagnosis were determined.
RESULTS
The average age of the patients was 33.5, and 44.7% were female. In 95.3% of the patients, leukocyte counts were 10000/mm3 and above. In 74.1% of the patients (63 patients), USG was performed, and 58.7% of the cases (37 patients) were compatible with AA. In four (4.7%) of the patients, AA was not found histopathologically (negative laparotomy). The sensitivity of leukocyte counts (≥10000/mm³) was 98.8% and its selectivity was 75%. The sensitivity of USG was 61.0% and its selectivity was 75%. When the areas under the receiver operating characteristics (ROC) curve were compared, leukocyte counts were more sensitive in determining the diagnosis.
CONCLUSION
In this study, the sensitivity of USG was lower than the high sensitivity ratios reported in the literature. However, the sensitivity of leukocyte counts was significantly higher than that of USG.

Keywords: Acute appendicitis, sensitivity; white blood cell counts; ultrasonography.

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ATIF KOPYALA