Poillucci Gaetano, Mortola Lorenzo, Podda Mauro, Di Saverio Salomone, Casula Laura, Gerardi Chiara, Cillara Nicola, Presenti Luigi
II Clinica Chirurgica, Policlinico Umberto I, Sapienza University, Rome, Italy.
Surgical Science Department, Cagliari State University, Policlinico Universitario Duilio Casula, Monserrato, Italy.
Updates Surg. 2017 Dec;69(4):531-540. doi: 10.1007/s13304-017-0499-8. Epub 2017 Nov 3.
Acute appendicitis (AA) is among the most common causes of acute lower abdominal pain leading patients to the emergency department. Significant debate remains on whether AA should be operated or not. A propensity score-matched analysis was performed in seven Italian Hospitals, with the aim to assess safety and feasibility both nonoperative management with antibiotics (AT) and surgical therapy with appendectomy (ST) for patients with AA. Data regarding all patients discharged from the participating centers with a diagnosis of appendicitis from January 1st, 2014 to December 31st, 2014 were collected retrospectively. Follow-up data were collected from January 1st, 2015 to December 31st, 2016. The complication-free treatment success of AT (53.7%) was significantly inferior to that of ST (86.4%) (P < 0.0001). Patients initially treated with antibiotics reported an index admission AT failure rate of 20.9% and a recurrence rate at 1-year follow-up of 20.3%. No statistically significant difference was found when comparing AT and ST groups for the outcome of interest post-operative complications (13.5 vs 13.6%, P = 0.834). Patients treated with AT were discharged home earlier than patients in the ST group (3.38 ± 1.89 vs 4.84 ± 2.69 days, P < 0.0001). Due to the low rates of complications occurred in the ST group and the high efficacy of the surgical therapy, laparoscopic appendectomy still represents the most effective treatment for patients with AA. AT is associated with shorter hospital stay and faster return to normal activity, and may prevent from appendectomies around 80% of patients who leave the hospital with clinical recovery.
急性阑尾炎（AA）是导致患者前往急诊科的急性下腹痛最常见的病因之一。对于AA是否应该进行手术，目前仍存在重大争议。在意大利的七家医院进行了一项倾向评分匹配分析，旨在评估抗生素非手术治疗（AT）和阑尾切除术手术治疗（ST）对AA患者的安全性和可行性。回顾性收集了2014年1月1日至2014年12月31日从参与中心出院且诊断为阑尾炎的所有患者的数据。随访数据收集于2015年1月1日至2016年12月31日。AT的无并发症治疗成功率（53.7%）显著低于ST（86.4%）（P < 0.0001）。最初接受抗生素治疗的患者报告指数入院时AT失败率为20.9%，1年随访时复发率为20.3%。比较AT组和ST组术后并发症这一感兴趣的结局时，未发现统计学上的显著差异（13.5%对13.6%，P = 0.834）。接受AT治疗的患者比ST组患者更早出院（3.38 ± 1.89天对4.84 ± 2.69天，P < 0.0001）。由于ST组并发症发生率低且手术治疗效果高，腹腔镜阑尾切除术仍然是AA患者最有效的治疗方法。AT与住院时间缩短和更快恢复正常活动相关，并且可能使约80%临床康复出院的患者避免阑尾切除术。
