Ahmed I, Deakin D, Parsons S L
Department of General Surgery, Queen's Medical Centre, Nottingham, UK.
Ann R Coll Surg Engl. 2005 May;87(3):191-5. doi: 10.1308/1478708051649.
The traditional management of appendiceal mass has been an initial conservative approach followed by interval appendicectomy. More recently, the necessity of interval appendicectomy has been questioned by a growing amount of evidence in the surgical literature. The aim of this study was to review the available scientific evidence and to determine how appendiceal masses are currently being managed in the Mid-Trent region by general surgeons.
PATIENTS & METHODS: A literature search using Medline, Embase, Cinahl, HMIC and Biosis was carried out. A personal or telephonic survey of all consultants and specialist registrars working in general surgery in the Mid-Trent region (n = 67) was conducted recording their management protocol of 3 different clinical scenarios--a 14-year-old boy, a 29-year-old female and a 68-year-old male. Responses of the questionnaire were entered to a database in Microsoft Access 2000 and analysed.
The results showed that there was difference of opinion on the management of appendix mass in either scenario. Appendectomy (interval or emergency) is still practised by 75% of general surgeons in the Mid-Trent region and less that 25% manage asymptomatic appendix mass without interval appendectomy. Additionally, specialist registrars appear more likely not to offer patients interval appendicectomy after successful conservative management (P < 0.05).
At present, there is no agreed consensus on the management of appendiceal mass. There is a need to develop a protocol for the management of this common problem.
传统上对阑尾肿块的处理是先采取保守治疗，随后进行择期阑尾切除术。最近，外科文献中越来越多的证据对择期阑尾切除术的必要性提出了质疑。本研究的目的是回顾现有的科学证据，并确定中特伦特地区的普通外科医生目前如何处理阑尾肿块。
利用医学文献数据库（Medline）、医学与健康领域数据库（Embase）、护理学与健康领域数据库（Cinahl）、英国医学保健信息中心数据库（HMIC）和生物科学数据库（Biosis）进行文献检索。对中特伦特地区所有从事普通外科工作的顾问医生和专科住院医生（n = 67）进行了个人或电话调查，记录他们对三种不同临床病例（一名14岁男孩、一名29岁女性和一名68岁男性）的处理方案。调查问卷的回复录入Microsoft Access 2000数据库并进行分析。
结果显示，在任何一种病例中，对于阑尾肿块的处理都存在意见分歧。中特伦特地区75%的普通外科医生仍会进行阑尾切除术（择期或急诊），不到25%的医生在无症状阑尾肿块的情况下不进行择期阑尾切除术。此外，专科住院医生在成功进行保守治疗后，似乎更有可能不给患者提供择期阑尾切除术（P < 0.05）。
目前，对于阑尾肿块的处理尚无一致的共识。需要制定一个处理这个常见问题的方案。
