Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, United States.
Am J Surg. 2019 Apr;217(4):713-717. doi: 10.1016/j.amjsurg.2018.12.061. Epub 2019 Jan 3.
The optimal treatment for complicated appendicitis remains controversial. We sought to compare clinical outcomes of patients with complicated appendicitis treated with an immediate operation or a trial of nonoperative management.
Adult patients (≥18 years) with complicated appendicitis were included. Patient characteristics and outcomes were compared between the immediate operation group and the nonoperative management group.
A total of 101 patients met our inclusion criteria. Of those, 36 patients received an initial trial of nonoperative management with an 86.1% success rate. Patients who failed nonoperative management required significantly longer hospital stays than those in the immediate operation group (11 vs. 5 days). An immediate operation was performed in 65 patients. Open surgery was required in 9 patients (13.8%). Postoperatively, 7 patients (10.8%) required percutaneous drainage of intraabdominal abscess.
Nonoperative management was successful in the majority of patients with complicated appendicitis, whereas failure of nonoperative management was associated with prolonged hospital stay. Patients who underwent an immediate operation often required percutaneous drainage of intraabdominal abscess.
复杂阑尾炎的最佳治疗方法仍存在争议。我们旨在比较立即手术与非手术治疗复杂阑尾炎患者的临床结果。
纳入成年（≥18 岁）复杂阑尾炎患者。比较立即手术组和非手术治疗组患者的特征和结局。
共纳入 101 例符合条件的患者，其中 36 例接受初始非手术治疗，成功率为 86.1%。非手术治疗失败的患者住院时间明显长于立即手术组（11 天 vs. 5 天）。65 例患者行立即手术，其中 9 例（13.8%）需要行开腹手术。术后，7 例（10.8%）患者需要经皮引流腹腔脓肿。
非手术治疗在大多数复杂阑尾炎患者中是成功的，而非手术治疗失败与住院时间延长相关。立即手术的患者常需要经皮引流腹腔脓肿。
