Rocha Leonardo Lima, Rossi Felipe Martin Bianco, Pessoa Camila Menezes Souza, Campos Flavia Nunes Dias, Pires Carlos Eduardo Fonseca, Steinman Milton
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil ; Telemedicine Service, Hospital Israelita Albert Einstein, Av. Albert Einstein, 2 andar, bloco D, São Paulo, CEP: 05651-901 Brazil.
Surgery Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
World J Emerg Surg. 2015 Oct 31;10:51. doi: 10.1186/s13017-015-0046-1. eCollection 2015.
Primary appendectomy is the current standard of care for treating uncomplicated acute appendicitis, but interest in conservative treatment with antibiotics alone has been increasing in recent years. Clinical trials so far have shown controversial results.
A series of meta-analyses were reviewed. Studies comparing surgery versus antibiotics alone for treating uncomplicated acute appendicitis in adults were included. Descriptive statistics and data on treatment effects were retrieved and summarized.
The conservative approach has a success rate of around 60 % and is associated with shorter pain duration, reduced analgesic medication, faster resolution of the inflammation process, lower expenses and quicker return to work. On the other hand, medical treatment leads to high (up to 20 %) readmission rates and more often requires surgery. An operative approach is associated with higher treatment success rates (>90 %) and very a low mortality rate.
Based on the current body of evidence, the use of antibiotics for primary treatment of uncomplicated acute appendicitis cannot be routinely recommended. Appendectomy remains the gold-standard treatment.
一期阑尾切除术是目前治疗单纯性急性阑尾炎的标准治疗方法，但近年来，单独使用抗生素进行保守治疗的关注度不断提高。迄今为止的临床试验结果存在争议。
回顾了一系列的荟萃分析。纳入了比较手术与单独使用抗生素治疗成人单纯性急性阑尾炎的研究。检索并总结了描述性统计数据和治疗效果数据。
保守治疗方法的成功率约为60%，且与疼痛持续时间缩短、止痛药物使用减少、炎症过程消退更快、费用降低以及更快恢复工作有关。另一方面，药物治疗导致高（高达20%）再入院率，且更常需要手术。手术治疗方法的治疗成功率更高（>90%），死亡率极低。
基于目前的证据，不能常规推荐使用抗生素对单纯性急性阑尾炎进行初始治疗。阑尾切除术仍然是金标准治疗方法。
