Tekin A, Kurtoğlu H C, Can I, Oztan S
Department of Surgery, Mersin City Hospital, Mersin, Turkey.
Colorectal Dis. 2008 Jun;10(5):465-8. doi: 10.1111/j.1463-1318.2007.01377.x. Epub 2007 Sep 13.
The traditional management of appendiceal mass is initial conservative treatment followed by interval appendicectomy. Recently interval appendicectomy has been questioned by a growing amount of evidence. The purpose of this study was to clarify the role of interval appendicectomy after successful initial conservative treatment.
The study included 98 patients with a mass in the right iliac fossa. Four (4%) patients were excluded wing to another diagnosis of appendiceal mass including caecal cancer (two), diverticulitis (one), and Crohn's disease (one). The remaining 94 patients were treated conservatively. Routine interval appendicectomy was not performed after successful conservative treatment.
Ultrasound (US)-guided drainage was performed in seven (7.4%) patients. Two were drained surgically because of a persistent abscess despite a previous US-guided drainage. In five (5.3%) patients, a delayed operation was necessary because of complications. One patient developed small bowel obstruction, and in three patients, conservative treatment was unsuccessful with the abscess remaining unresolved. Within 3 months, seven out of the 89 patients were readmitted to hospital with a recurrent mass in two patients and acute appendicitis without a mass in five patients. Six (6.7%) patients were readmitted with recurrent appendicitis after 3 months. The recurrence rate after successful conservative treatment was 14.6%. The majority (nine patients; 10.1%) of the recurrences occurred within the first 6 months, and after 1 year the recurrence rate was very low (two patients; 2.2%).
Routine interval appendicectomy after initial successful conservative treatment is not justified and should be abandoned. At present, there is no consensus for the management of appendiceal mass. There is, therefore, a need to develop a protocol for the management of this common problem.
阑尾肿块的传统治疗方法是先进行保守治疗，然后择期行阑尾切除术。最近，越来越多的证据对择期阑尾切除术提出了质疑。本研究的目的是阐明在初始保守治疗成功后择期阑尾切除术的作用。
本研究纳入了98例右下腹有肿块的患者。4例（4%）患者因另一种诊断而被排除，包括盲肠癌（2例）、憩室炎（1例）和克罗恩病（1例）。其余94例患者接受了保守治疗。保守治疗成功后未进行常规择期阑尾切除术。
7例（7.4%）患者接受了超声引导下引流。2例因尽管先前进行了超声引导下引流但脓肿持续存在而接受了手术引流。5例（5.3%）患者因并发症需要延迟手术。1例患者发生小肠梗阻，3例患者保守治疗失败，脓肿仍未消退。在3个月内，89例患者中有7例再次入院，2例复发肿块，5例急性阑尾炎但无肿块。6例（6.7%）患者在3个月后因复发性阑尾炎再次入院。保守治疗成功后的复发率为14.6%。大多数复发（9例患者；10.1%）发生在最初6个月内，1年后复发率非常低（2例患者；2.2%）。
初始保守治疗成功后进行常规择期阑尾切除术是不合理的，应予以摒弃。目前，对于阑尾肿块的治疗尚无共识。因此，需要制定一个针对这个常见问题的治疗方案。
