Forsyth James, Lasithiotakis Konstantinos, Peter Mark
Department of General Surgery, Scarborough General Hospital, York Teaching Hospitals NHS Foundation Trust, UK.
Surgeon. 2017 Apr;15(2):109-115. doi: 10.1016/j.surge.2016.08.002. Epub 2016 Sep 6.
An appendix mass is the result of a walled-off perforation of the appendix which localises, resulting in a mass and it is encountered in up to 7% of patients presenting with acute appendicitis. However, its management is controversial due to the lack of high level evidence. This review article sets out a rationale diagnostic and therapeutic strategy for the appendix mass based upon up-to-date available evidence.
A literature review of the investigation and management of appendix mass/complicated appendicitis was undertaken using PubMed, EMBASE and Google Scholar.
RESULTS/CONCLUSION: No prospective studies were identified. The great majority of recent evidence supports a conservative management approach avoiding urgent appendicectomy because of the high risk of major complications and bowel resection. Appendix abscesses over 5 cm in diameter and persistent abscesses should be drained percutaneously along with antibiotics. Appendix phlegmon should be treated with antibiotics alone. Surgery is reserved for patients who fail conservative treatment. Routine interval appendicectomy is not recommended, but should be considered in the context of persistent faecolith, ongoing right iliac fossa pain, recurrent appendicitis and appendix mass persistent beyond 2 weeks. Clinicians should be particularly wary of patients with appendix mass aged over 40 and those with features suggesting malignancy.
阑尾包块是阑尾壁穿孔后局部包裹形成的，在急性阑尾炎患者中发生率高达7%。然而，由于缺乏高级别证据，其治疗存在争议。本文基于现有最新证据，阐述阑尾包块合理的诊断和治疗策略。
利用PubMed、EMBASE和谷歌学术对阑尾包块/复杂性阑尾炎的检查和治疗进行文献综述。
结果/结论：未检索到前瞻性研究。绝大多数最新证据支持保守治疗方法，避免急诊阑尾切除术，因为发生严重并发症和肠切除的风险较高。直径超过5厘米的阑尾脓肿和持续性脓肿应在使用抗生素的同时进行经皮引流。阑尾蜂窝织炎应仅用抗生素治疗。手术适用于保守治疗失败的患者。不建议常规进行间隔期阑尾切除术，但在存在持续粪石、右下腹持续疼痛、复发性阑尾炎以及阑尾包块持续超过2周的情况下应考虑手术。临床医生应特别警惕年龄超过40岁的阑尾包块患者以及有恶性肿瘤特征的患者。
