Mak Grace Zee, Loeff Deborah S
Pediatr Ann. 2016 Jul 1;45(7):e235-40. doi: 10.3928/00904481-20160525-01.
Acute appendicitis is the most common cause of emergent surgery in children. Historically, surgical dogma dictated emergent appendectomy due to concern for impending perforation. Recently, however, there has been a paradigm shift in both the understanding of its pathophysiology as well as its treatment to more nonoperative management. No longer is it considered a spectrum from uncomplicated appendicitis inevitably progressing to complicated appendicitis over time. Rather, uncomplicated and complicated appendicitis are now considered two distinct pathophysiologic entities. This change requires not only educating the patients and their families but also the general practitioners who will be managing treatment expectations and caring for patients long term. In this article, we review the pathophysiology of appendicitis, including the differentiation between uncomplicated and complicated appendicitis, as well as the new treatment paradigms. [Pediatr Ann. 2016;45(7):e235-e240.].
急性阑尾炎是儿童急诊手术最常见的病因。从历史上看，由于担心即将发生穿孔，手术教条规定应进行急诊阑尾切除术。然而，最近在其病理生理学的理解以及治疗方面都发生了范式转变，转向更多的非手术治疗。它不再被认为是一个从单纯性阑尾炎随着时间推移不可避免地发展为复杂性阑尾炎的连续过程。相反，单纯性和复杂性阑尾炎现在被认为是两种不同的病理生理实体。这种变化不仅需要对患者及其家属进行教育，还需要对那些将管理治疗期望并长期照顾患者的全科医生进行教育。在本文中，我们回顾了阑尾炎的病理生理学，包括单纯性和复杂性阑尾炎的鉴别，以及新的治疗范式。[《儿科年鉴》。2016年；45(7):e235 - e240。]
