Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, 416 85 Goteborg, Sweden.
World J Surg. 2012 Sep;36(9):2028-36. doi: 10.1007/s00268-012-1641-x.
Randomized studies have indicated that acute appendicitis may be treated by antibiotics without the need of surgery. However, concerns have been raised about selection bias of patients in such studies. Therefore, the present study was aimed to validate previous findings in randomized studies by a full-scale population-based application.
All patients with acute appendicitis at Sahlgrenska University Hospital (May 2009 and February 2010) were offered intravenous piperacillin plus tazobactam according to our previous experience, followed by 9 days out-hospital oral ciprofloxacin plus metronidazole. Endpoints were treatment efficacy and complications. Efficient antibiotic treatment was defined as recovery without the need of surgery beyond 1 year of follow-up.
A total of 558 consecutive patients were hospitalized and treated due to acute appendicitis. Seventy-nine percent (n = 442) received antibiotics as first-line therapy and 20 % (n = 111) had primary surgery as the second-line therapy. Seventy-seven percent of patients on primary antibiotics recovered while 23 % (n = 100) had subsequent appendectomy due to failed initial treatment on antibiotics. Thirty-eight patients (11 %) of the 342 had experienced recurrent appendicitis at 1-year follow-up. Primary antibiotic treatment had fewer complications compared to primary surgery.
This population-based study confirms previous results of randomized studies. Antibiotic treatment can be offered as the first-line therapy to a majority of unselected patients with acute appendicitis without medical drawbacks other than the unknown risk for long-term relapse, which must be weighed against the unpredicted but well-known risk for serious major complications following surgical intervention.
随机研究表明，急性阑尾炎可以通过抗生素治疗而无需手术。然而，人们对这些研究中患者的选择偏倚提出了担忧。因此，本研究旨在通过全面的基于人群的应用来验证先前随机研究的结果。
根据我们之前的经验，所有在 Sahlgrenska 大学医院就诊的急性阑尾炎患者（2009 年 5 月至 2010 年 2 月）均给予静脉注射哌拉西林加他唑巴坦，然后在院外口服 9 天环丙沙星加甲硝唑。终点是治疗效果和并发症。有效的抗生素治疗定义为在 1 年随访期内无需手术即可恢复。
共有 558 例连续患者因急性阑尾炎住院并接受治疗。79%（n = 442）接受抗生素作为一线治疗，20%（n = 111）作为二线治疗接受了初次手术。接受一线抗生素治疗的患者中有 77%恢复，而 23%（n = 100）因初始抗生素治疗失败而随后进行了阑尾切除术。在 1 年随访时，38 例（11%）患者出现复发性阑尾炎。与初次手术相比，一线抗生素治疗的并发症较少。
这项基于人群的研究证实了先前随机研究的结果。对于大多数未经选择的急性阑尾炎患者，可以提供抗生素治疗作为一线治疗，除了长期复发的未知风险外，没有其他医疗弊端，必须权衡手术干预后不可预测但众所周知的严重主要并发症的风险。
