Huang Libin, Yin Yuan, Yang Lie, Wang Cun, Li Yuan, Zhou Zongguang
Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China2Laboratory of Digestive Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China.
Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China.
JAMA Pediatr. 2017 May 1;171(5):426-434. doi: 10.1001/jamapediatrics.2017.0057.
Antibiotic therapy for acute uncomplicated appendicitis is effective in adult patients, but its application in pediatric patients remains controversial.
To compare the safety and efficacy of antibiotic treatment vs appendectomy as the primary therapy for acute uncomplicated appendicitis in pediatric patients.
The PubMed, MEDLINE, EMBASE, and Cochrane Library databases and the Cochrane Controlled Trials Register for randomized clinical trials were searched through April 17, 2016. The search was limited to studies published in English. Search terms included appendicitis, antibiotics, appendectomy, randomized controlled trial, controlled clinical trial, randomized, placebo, drug therapy, randomly, and trial.
Randomized clinical trials and prospective clinical controlled trials comparing antibiotic therapy with appendectomy for acute uncomplicated appendicitis in pediatric patients (aged 5-18 years) were included in the meta-analysis. The outcomes included at least 2 of the following terms: success rate of antibiotic treatment and appendectomy, complications, readmissions, length of stay, total cost, and disability days.
Data were independently extracted by 2 reviewers. The quality of the included studies was examined in accordance with the Cochrane guidelines and the Newcastle-Ottawa criteria. Data were pooled using a logistic fixed-effects model, and the subgroup pooled risk ratio with or without appendicolith was estimated.
The primary outcome was the success rate of treatment. The hypothesis was formulated before data collection.
A total of 527 articles were screened. In 5 unique studies, 404 unique patients with uncomplicated appendicitis (aged 5-15 years) were enrolled. Nonoperative treatment was successful in 152 of 168 patients (90.5%), with a Mantel-Haenszel fixed-effects risk ratio of 8.92 (95% CI, 2.67-29.79; heterogeneity, P = .99; I2 = 0%). Subgroup analysis showed that the risk for treatment failure in patients with appendicolith increased, with a Mantel-Haenszel fixed-effects risk ratio of 10.43 (95% CI, 1.46-74.26; heterogeneity, P = .91; I2 = 0%).
This meta-analysis shows that antibiotics as the initial treatment for pediatric patients with uncomplicated appendicitis may be feasible and effective without increasing the risk for complications. However, the failure rate, mainly caused by the presence of appendicolith, is higher than for appendectomy. Surgery is preferably suggested for uncomplicated appendicitis with appendicolith.
抗生素疗法对成年急性单纯性阑尾炎患者有效，但其在儿科患者中的应用仍存在争议。
比较抗生素治疗与阑尾切除术作为儿科急性单纯性阑尾炎主要治疗方法的安全性和有效性。
检索了截至2016年4月17日的PubMed、MEDLINE、EMBASE和Cochrane图书馆数据库以及Cochrane对照试验注册库中的随机临床试验。检索限于以英文发表的研究。检索词包括阑尾炎、抗生素、阑尾切除术、随机对照试验、临床对照试验、随机、安慰剂、药物治疗、随机地和试验。
纳入比较抗生素疗法与阑尾切除术治疗儿科（5 - 18岁）急性单纯性阑尾炎的随机临床试验和前瞻性临床对照试验进行荟萃分析。结局包括以下至少2项：抗生素治疗和阑尾切除术的成功率、并发症、再入院率、住院时间、总成本和残疾天数。
由2名审阅者独立提取数据。根据Cochrane指南和纽卡斯尔 - 渥太华标准检查纳入研究的质量。使用逻辑固定效应模型汇总数据，并估计有无阑尾粪石的亚组汇总风险比。
主要结局是治疗成功率。在数据收集前制定假设。
共筛选527篇文章。在5项独特研究中，纳入了404例单纯性阑尾炎（5 - 15岁）的独特患者。168例患者中有152例（90.5%）非手术治疗成功，Mantel - Haenszel固定效应风险比为8.92（95%CI，2.67 - 29.79；异质性，P = 0.99；I² = 0%）。亚组分析显示，有阑尾粪石患者治疗失败风险增加，Mantel - Haenszel固定效应风险比为10.43（95%CI，1.46 - 74.26；异质性，P = 0.91；I² = 0%）。
这项荟萃分析表明，抗生素作为儿科单纯性阑尾炎患者的初始治疗可能可行且有效，而不会增加并发症风险。然而，主要由阑尾粪石导致的失败率高于阑尾切除术。对于伴有阑尾粪石的单纯性阑尾炎，建议首选手术治疗。
