Department of Surgery, Tergooi Hospital Hilversum, P.O. Box 10016, 1201DA, Hilversum, The Netherlands.
Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 22660, 1105AZ, Amsterdam, The Netherlands.
Int J Colorectal Dis. 2019 Jul;34(7):1325-1332. doi: 10.1007/s00384-019-03303-4. Epub 2019 Jun 7.
To determine the incidence rate and identify predictive factors for interval appendectomy after non-operatively treated complicated appendicitis.
Single-center retrospective cohort study conducted between January 2008 and June 2017. Adult patients with acute appendicitis were identified. Patients with complicated appendicitis initially treated non-operatively were included. Outcomes included abscess rate on imaging, results of additional imaging during follow-up, incidence rate of and surgical indications for interval appendectomy, and outcomes of histological reports.
Of all adult patients with acute appendicitis (n = 1839), 9% (170/1839) was initially treated non-operatively. Median age of these patients was 55 years (IQR 42-65) and 48.8% (83/170) were men. In 36.4% (62/170) of the patients, an appendicular abscess was diagnosed. 62.4% (106/170) did not require subsequent surgery (no interval appendectomy group) and in 37.6% (64/170), an interval appendectomy was performed (interval appendectomy group). Median follow-up was 80 weeks (17-192) and 113 weeks (34-246), respectively. Most frequent reason to perform subsequent surgery was recurrent appendicitis (45% (29/64)). Increasing age was significantly associated with a lower risk of undergoing interval appendectomy (OR 0.7; CI 0.6-0.89); p = 0.002). In the interval appendectomy group, appendicular neoplasm was found in 11% (7/64) of the patients, in contrast to 1.5% (25/1669) of the patients that had acute surgery (p < 0.001).
One out of three patients non-operatively treated for complicated appendicitis required an interval appendectomy. The incidence of appendicular neoplasms was high in these patients compared with those that had acute surgery. Therefore, additional radiological imaging following non-operatively treated complicated appendicitis is recommended.
确定经非手术治疗的复杂性阑尾炎后行间隔性阑尾切除术的发生率，并确定其预测因素。
这是一项 2008 年 1 月至 2017 年 6 月间进行的单中心回顾性队列研究。研究纳入急性阑尾炎的成年患者。纳入初始非手术治疗的复杂性阑尾炎患者。研究结果包括影像学检查发现脓肿的比例、随访时额外影像学检查的结果、间隔性阑尾切除术的发生率和手术指征以及组织学报告的结果。
在所有急性阑尾炎成年患者（n=1839）中，有 9%（170/1839）初始非手术治疗。这些患者的中位年龄为 55 岁（IQR 42-65），其中 48.8%（83/170）为男性。在 36.4%（62/170）的患者中，诊断为阑尾脓肿。62.4%（106/170）的患者无需进一步手术（无间隔性阑尾切除术组），37.6%（64/170）的患者行间隔性阑尾切除术（间隔性阑尾切除术组）。中位随访时间分别为 80 周（17-192）和 113 周（34-246）。行进一步手术的最常见原因是阑尾炎复发（45%（29/64））。年龄增长与间隔性阑尾切除术的风险降低显著相关（OR 0.7；95%CI 0.6-0.89）；p=0.002）。在间隔性阑尾切除术组中，11%（7/64）的患者发现阑尾肿瘤，而在急性手术组（1669 例患者）中，这一比例为 1.5%（25/1669）（p<0.001）。
在经非手术治疗的复杂性阑尾炎患者中，有三分之一需要行间隔性阑尾切除术。与行急性手术的患者相比，这些患者的阑尾肿瘤发生率较高。因此，建议对经非手术治疗的复杂性阑尾炎患者进行额外的影像学检查。
