Division of General and Laparoscopic Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
Surg Infect (Larchmt). 2012 Apr;13(2):74-84. doi: 10.1089/sur.2011.058. Epub 2012 Feb 24.
The objective was to conduct a meta-analysis of randomized controlled trials evaluating the efficacy and morbidity of the management of acute uncomplicated (no abscess or phlegmon) appendicitis by antibiotics versus appendectomy.
Appropriate trials were identified. The seven outcome variables were overall complication rate, treatment failure rate for index hospital admission, overall treatment failure rate, length of stay (LOS), utilization of pain medication, duration of pain, and sick leave. Both fixed and random effects meta-analyses were performed using odds ratios (ORs) and weighted or standardized mean differences (WMDs or SMDs, respectively).
Five trials totaling 980 patients (antibiotics=510, appendectomy=470) were analyzed. In three of the seven outcome analyses, the summary point estimates favored antibiotics over appendectomy, with a 46% reduction in the relative odds of complications (OR 0.54; 95% confidence interval [CI] 0.37, 0.78; p=0.001); a reduction in sick leave/disability (SMD -0.19; CI -0.33, -0.06; p=0.005), and decreased pain medication utilization (SMD -1.55; CI -1.96, -1.14; p<0.0001). For overall treatment failure, the summary point estimate favored appendectomy, with a 40.2% failure rate for antibiotics versus 8.5% for appendectomy (OR 6.72; CI 0.08, 12.99; p<0.001). Initial treatment failure, LOS, and pain duration were similar in the two groups.
Non-operative management of uncomplicated appendicitis with antibiotics was associated with significantly fewer complications, better pain control, and shorter sick leave, but overall had inferior efficacy because of the high rate of recurrence in comparison with appendectomy.
本研究旨在对评估抗生素治疗与阑尾切除术治疗急性单纯性（无脓肿或蜂窝织炎）阑尾炎的疗效和发病率的随机对照试验进行荟萃分析。
确定合适的试验。七个结局变量为总并发症发生率、索引住院治疗失败率、总治疗失败率、住院时间（LOS）、疼痛药物的使用、疼痛持续时间和病假。使用优势比（ORs）和加权或标准化均数差（WMDs 或 SMDs，分别）进行固定效应和随机效应荟萃分析。
分析了 5 项总计 980 例患者的试验（抗生素=510 例，阑尾切除术=470 例）。在七个结局分析中的三个分析中，汇总点估计值支持抗生素优于阑尾切除术，并发症的相对比值降低了 46%（OR 0.54；95%置信区间 [CI] 0.37，0.78；p=0.001）；病假/残疾减少（SMD -0.19；CI -0.33，-0.06；p=0.005），以及疼痛药物的使用减少（SMD -1.55；CI -1.96，-1.14；p<0.0001）。对于总治疗失败，汇总点估计值支持阑尾切除术，抗生素的总体失败率为 40.2%，而阑尾切除术的失败率为 8.5%（OR 6.72；CI 0.08，12.99；p<0.001）。两组初始治疗失败、LOS 和疼痛持续时间相似。
与阑尾切除术相比，抗生素治疗单纯性阑尾炎与并发症显著减少、疼痛控制更好、病假时间更短相关，但由于与阑尾切除术相比，复发率较高，总体疗效较差。
