Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA.
Surg Infect (Larchmt). 2020 Aug;21(6):523-532. doi: 10.1089/sur.2019.365. Epub 2020 Feb 5.
Acute appendicitis is one of the most common surgical emergencies globally. Its incidence is increasing in low- and middle-Human Development Index countries (LMHDICs). Although a proportion of patients can be treated successfully with non-operative management consisting of antibiotics, supportive therapy, and close observation, current diagnostic algorithms lack the granularity to identify these patients accurately. We reviewed published literature describing practice patterns and clinical outcomes for appendicitis in LMHDICs and compared them with studies from high-Human Development Index countries, as well as guidelines published by international surgical societies. We identified shortcomings in current diagnostic and therapeutic strategies used in LMHDICs. Delays in obtaining surgical care inherent in many LMHDIC healthcare systems make prompt surgical care the mainstay for the treatment of acute appendicitis. Laparoscopic appendectomy leads to better outcomes than open appendectomy in resource-constrained settings and when available should be the surgical technique of choice. Acute appendicitis is common in LMHDICs, and if possible, laparoscopic appendectomy should be the procedure of choice.
急性阑尾炎是全球最常见的外科急症之一。在中低人类发展指数国家（LMHDICs），其发病率正在上升。尽管一部分患者可以通过非手术治疗成功治疗，包括抗生素、支持疗法和密切观察，但目前的诊断算法缺乏准确识别这些患者的粒度。我们回顾了描述 LMHDIC 中阑尾炎的实践模式和临床结果的已发表文献，并将其与来自高人类发展指数国家的研究以及国际外科协会发布的指南进行了比较。我们发现了 LMHDIC 中当前诊断和治疗策略的不足之处。许多 LMHDIC 医疗保健系统中存在获得手术护理的延迟，这使得及时的手术护理成为急性阑尾炎治疗的主要方法。在资源有限的情况下，腹腔镜阑尾切除术比开腹阑尾切除术效果更好，只要可行，就应该是首选的手术技术。急性阑尾炎在 LMHDICs 很常见，如果可能的话，腹腔镜阑尾切除术应该是首选的手术方法。
