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JACS:长期随访结果显示无并发症的阑尾炎患者保守治疗是安全的

2014-10-18 MedSci MedSci原创

有关急性阑尾炎的治疗目前仍然存在争议。有些研究认为,急性阑尾炎应该及时进行手术治疗,也有研究认为,可以不必用开放手术,建议选择内镜下手术。更有研究认为,如果急性阑尾炎没有并发症,完全可以采用抗生素治疗。最新一项研究发表J Am Coll Surg上,认为无并发症的急性阑尾炎患者采取保守治疗是安全的。 本研究采用第 9 版国际疾病分类(ICD-9)诊断编码,识别1997~2008

有关急性阑尾炎的治疗目前仍然存在争议。有些研究认为,急性阑尾炎应该及时进行手术治疗,也有研究认为,可以不必用开放手术,建议选择内镜下手术。更有研究认为,如果急性阑尾炎没有并发症,完全可以采用抗生素治疗(BMJ:抗生素可免去单纯性阑尾炎患者的手术之苦)。最新一项研究发表J Am Coll Surg上,认为无并发症的急性阑尾炎患者采取保守治疗是安全的。

本研究采用第 9 版国际疾病分类(ICD-9)诊断编码,识别1997~2008 年间加利福尼亚州健康计划与发展办公室数据库中的急性无并发症阑尾炎患者。统计其中保守治疗患者的治疗失败、复发和穿孔发生率。应用多因素 logistic 回归分析法分析与治疗失败、复发和穿孔相关的因素。进一步采用倾向性评分匹配(PSM)分析比较保守治疗与手术治疗患者的死亡率、住院时间和总体治疗费用的差异。

结果发现,共确定了 231 678 例无并发症的阑尾炎患者,其中绝大多数(98.5%)均接受了手术治疗。共 3236 例患者接受了保守治疗并幸存出院,其在超过 7 年的中位随访时间内,均未行阑尾切除术,治疗失败和复发率分别为 5.9% 和 4.4%。未发生因治疗失败或疾病复发导致的死亡。接受保守治疗的患者出院后穿孔发生风险约为 3%。多因素分析结果显示,种族和年龄与治疗失败风险显著相关。性别、年龄和住院期间是否接受健康宣教均与疾病复发风险显著相关。年龄和住院期间是否接受健康宣教同时也与穿孔风险显著相关。倾向性评分匹配分析结果表明,校正风险后,接受手术治疗和保守治疗患者的死亡率(0.1% vs. 0.3% ; P =0.65)和总体治疗费用(23 243 vs. 24 793 美元 ; P =0.70)无明显差异 ; 然而,接受保守治疗者的住院时间明显较长(3.2 vs. 2.1 d, P < 0.001) 。

本研究结果提示,无并发症的阑尾炎患者接受保守治疗是安全的,但是,仍需更多的研究结论支持。尤其需要开展前瞻性的随机对照研究来进行疗效比较。

不过,最近一项发表在J Infect上的荟萃分析认为(J Infect. 2014 Aug 29. pii: S0163-4453(14)00269-2.),无并发症的阑尾炎保守治疗的并发症仍然高于手术治疗。但本Meta分析并未纳入这项大型研究。

原始出处:
Minneci PC, Sulkowski JP, Nacion KM, Mahida JB, Cooper JN, Moss RL, Deans KJ.Feasibility of a nonoperative management strategy for uncomplicated acute appendicitis in children.J Am Coll Surg. 2014 Aug;219(2):272-9

其它文献:
Casarotto A, Zarantonello FR, Rebonato M.Appendectomy in women. Is the laparoscopic approach always better than the "open" approach in uncomplicated appendicitis?Surg Laparosc Endosc Percutan Tech. 2014 Oct;24(5):406-9.

Park HC, Kim MJ, Lee BH.The outcome of antibiotic therapy for uncomplicated appendicitis with diameters ≤10 mm.Int J Surg. 2014;12(9):897-900.

Kirby A, Hobson RP, Burke D, Cleveland V, Ford G, West RM.Appendicectomy for suspected uncomplicated appendicitis is associated with fewer complications than conservative antibiotic management: A meta-analysis of post-intervention complications.J Infect. 2014 Aug 29. pii: S0163-4453(14)00269-2.

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    2014-12-14 丁鹏鹏
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    2014-10-20 yaanren
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马路上的减速带与阑尾炎有什么关系?许多腹痛、疑似急性阑尾炎的患者都是被救护车一路飞奔拉到医院的,而车辆在路上经过减速带时不免要颠簸一下。英国研究人员发现,患者在颠簸中的反应有助于诊断急性阑尾炎。 英国牛津大学等机构研究人员在新一期《英国医学杂志》上报告说,最开始是偶然发现“减速带有助于诊断阑尾炎”,后来专门进行了统计研究,询问了64名在乘车前往医院途中经过了减速带的患者的情况,其中大部分人在颠簸

BMJ:抗生素可免去单纯性阑尾炎患者的手术之苦

近日,诺丁汉大学专家们在最新发表于国际著名杂志BMJ上的论文中指出,让单纯性急性阑尾炎患者服用抗生素是一种可取代手术的既安全又可行的方法。 自1989年以来,通过手术摘除发炎的阑尾一直是治疗阑尾炎的最被认可的方法。常见的说法是,如果不做手术的话,发生并发症如穿孔或感染的风险会很高。然而,近期的研究表明使用抗生素治疗比采用手术治疗单纯性阑尾炎的效果更好。但一直没有定论。 因此,诺丁汉大学消化道疾

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