Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham NG7 2UH, UK.
BMJ. 2012 Apr 5;344:e2156. doi: 10.1136/bmj.e2156.
To compare the safety and efficacy of antibiotic treatment versus appendicectomy for the primary treatment of uncomplicated acute appendicitis.
Meta-analysis of randomised controlled trials.
Randomised controlled trials of adult patients presenting with uncomplicated acute appendicitis, diagnosed by haematological and radiological investigations.
Antibiotic treatment versus appendicectomy.
The primary outcome measure was complications. The secondary outcome measures were efficacy of treatment, length of stay, and incidence of complicated appendicitis and readmissions.
Four randomised controlled trials with a total of 900 patients (470 antibiotic treatment, 430 appendicectomy) met the inclusion criteria. Antibiotic treatment was associated with a 63% (277/438) success rate at one year. Meta-analysis of complications showed a relative risk reduction of 31% for antibiotic treatment compared with appendicectomy (risk ratio (Mantel-Haenszel, fixed) 0.69 (95% confidence interval 0.54 to 0.89); I(2)=0%; P=0.004). A secondary analysis, excluding the study with crossover of patients between the two interventions after randomisation, showed a significant relative risk reduction of 39% for antibiotic therapy (risk ratio 0.61 (0.40 to 0.92); I(2)=0%; P=0.02). Of the 65 (20%) patients who had appendicectomy after readmission, nine had perforated appendicitis and four had gangrenous appendicitis. No significant differences were seen for treatment efficacy, length of stay, or risk of developing complicated appendicitis.
Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis.
比较抗生素治疗与阑尾切除术治疗单纯性急性阑尾炎的安全性和疗效。
随机对照试验的荟萃分析。
接受单纯性急性阑尾炎诊断的成年患者的随机对照试验，通过血液学和影像学检查。
抗生素治疗与阑尾切除术。
主要结局指标是并发症。次要结局指标是治疗效果、住院时间、复杂性阑尾炎和再入院的发生率。
符合纳入标准的共有 4 项随机对照试验，共 900 例患者（470 例抗生素治疗，430 例阑尾切除术）。抗生素治疗 1 年的成功率为 63%（277/438）。荟萃分析显示，与阑尾切除术相比，抗生素治疗的并发症相对风险降低了 31%（风险比（Mantel-Haenszel，固定）0.69（95%置信区间 0.54 至 0.89）；I²=0%；P=0.004）。排除随机分组后两种干预措施之间交叉患者的研究后进行二次分析，抗生素治疗的相对风险降低了 39%（风险比 0.61（0.40 至 0.92）；I²=0%；P=0.02）。在 65 例（20%）再次入院接受阑尾切除术的患者中，9 例发生穿孔性阑尾炎，4 例发生坏疽性阑尾炎。在治疗效果、住院时间或发生复杂性阑尾炎的风险方面，未观察到显著差异。
抗生素作为单纯性急性阑尾炎的初始治疗既有效又安全。初始抗生素治疗值得考虑作为早期单纯性阑尾炎的主要治疗选择。
