复杂阑尾炎的结局：保守治疗真的像看起来那么顺利吗？
Outcomes of complicated appendicitis: Is conservative management as smooth as it seems?
机构信息
Department of General Surgery, Geisinger Medical Center, 100 N. Academy Avenue, Danville, PA, USA.
出版信息
Am J Surg. 2018 Apr;215(4):586-592. doi: 10.1016/j.amjsurg.2017.10.032. Epub 2017 Nov 1.
BACKGROUND
This study characterized the failure rate of non-operative management (NOM) for complicated appendicitis (CA; perforation, abscess, phlegmon), and compared outcomes among patients undergoing acute appendectomy (AA), elective interval appendectomy (EIA), and unplanned appendectomy after failing to improve with NOM.
METHODS
Adults treated at one facility between 2007 and 2014 were retrospectively studied.
RESULTS
Ninety-five patients presented with CA. Sixty individuals underwent AA. The remaining 35 patients initially underwent NOM: 14 underwent EIA, nine (25.7%) failed NOM, 12 never underwent surgery. All patients failing NOM had an open operation with most (55.6%) requiring bowel resection. AA and EIA were comparable in surgical approach, bowel resection and post-operative readmission. However, AA demonstrated a lower incidence of bowel resection (3.3% vs 17.1%, P = 0.048) when compared to all patients initially undergoing NOM.
CONCLUSIONS
Due to the high incidence of failed NOM and the morbidity associated with failure, AA may be appropriate for CA.
背景
本研究旨在描述复杂性阑尾炎（穿孔、脓肿、蜂窝织炎）非手术治疗（NOM）的失败率，并比较行急性阑尾切除术（AA）、择期间隔阑尾切除术（EIA）以及 NOM 治疗失败后行计划性阑尾切除术的患者结局。
方法
回顾性研究了 2007 年至 2014 年在一家医疗机构治疗的成年人。
结果
95 例患者表现为 CA。60 例患者接受了 AA。其余 35 例患者最初接受了 NOM：14 例接受了 EIA，9 例（25.7%）NOM 治疗失败，12 例从未接受过手术。所有 NOM 治疗失败的患者均行剖腹手术，其中大多数（55.6%）需要肠切除术。AA 和 EIA 的手术方法、肠切除术和术后再入院率相似。然而，与最初接受 NOM 的所有患者相比，AA 肠切除术的发生率较低（3.3%比 17.1%，P=0.048）。
结论
由于 NOM 治疗失败的发生率较高，且与失败相关的发病率较高，因此 AA 可能适用于 CA。
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