Steiner Zvi, Buklan Genady, Stackievicz Rodica, Gutermacher Michael, Litmanovitz Ita, Golani Guy, Arnon Shmuel
Department of Pediatric Surgery, Meir Medical Center, 44281, Kfar Saba, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Eur J Pediatr. 2017 Apr;176(4):521-527. doi: 10.1007/s00431-017-2867-2. Epub 2017 Feb 16.
The success rate of conservative treatment for children with uncomplicated appendicitis was prospectively evaluated among 197 children. All who received intravenous antibiotics for 3-5 days, and if symptoms resolved, were discharged home on oral antibiotics for 5 days. Failure rate, symptoms, laboratory signs, and sonographic findings were evaluated for prognostic markers of treatment failure. Children were followed for 18 months. The success rate of conservative treatment was 87%, with shorter hospital stays compared to children who eventually needed surgery (72 [60-84] vs. 84 h [72-126], P = 0.001). Vomiting and/or nausea and intraluminal fluid on sonography were the only prognostic signs of failed treatment (P = 0.028 and P = 0.0001, respectively). After multi-regression analysis, intraluminal fluid was the only prognostic sign for failed treatment (odds ratio = 10.2; 95% CI 3.3-31.8, P = 0.001). Patients who failed conservative treatment were successfully operated without significant morbidity. Pathology findings were compatible with acute or subacute inflammation in 94% of operated AA, with no perforated appendices.
When applying rigorous criteria for children with uncomplicated appendicitis, a high success rate can be achieved with conservative treatment. Those who fail conservative treatment have a benign medical course without serious complications. Intraluminal fluid may increase risk for conservative treatment failure. What is Known: • Conservative treatment in uncomplicated acute appendicitis is a reasonable alternative to appendectomy. What is New: • Using rigorous criteria for conservative treatment in uncomplicated acute appendicitis is safe and feasible. • Intraluminal fluid should be considered a contraindication to conservative treatment.
前瞻性评估了197例单纯性阑尾炎患儿的保守治疗成功率。所有患儿接受3 - 5天静脉抗生素治疗，若症状缓解，则出院口服抗生素5天。评估失败率、症状、实验室指标及超声检查结果作为治疗失败的预后标志物。对患儿随访18个月。保守治疗成功率为87%，与最终需要手术的患儿相比，住院时间更短（72[60 - 84]小时 vs. 84小时[72 - 126]，P = 0.001）。呕吐和/或恶心以及超声检查显示腔内积液是治疗失败的唯一预后征象（分别为P = 0.028和P = 0.0001）。多因素回归分析后，腔内积液是治疗失败的唯一预后征象（比值比 = 10.2；95%可信区间3.3 - 31.8，P = 0.001）。保守治疗失败的患者成功接受了手术，且无明显并发症。94%接受手术的急性阑尾炎患者病理结果与急性或亚急性炎症相符，无阑尾穿孔。
对单纯性阑尾炎患儿应用严格标准时，保守治疗可取得较高成功率。保守治疗失败的患儿病情良性，无严重并发症。腔内积液可能增加保守治疗失败的风险。已知信息：• 单纯性急性阑尾炎的保守治疗是阑尾切除术的合理替代方案。新发现：• 对单纯性急性阑尾炎采用严格的保守治疗标准是安全可行的。• 腔内积液应被视为保守治疗的禁忌证。
