Lewin J, Fenyö G, Engström L
Department of Surgery, Nacka Hospital, Stockholm, Sweden.
Acta Chir Scand. 1988 Feb;154(2):123-5.
Appendiceal abscess occurring in 193 patients during a 14-year period is reviewed. Treatment was nonsurgical in 98 patients, with a complication rate of 3%. In the 95 surgically treated patients the complication rate was 32%. One patient died. 'Interval' elective appendectomy was performed in 80 cases and the complication rate was 23%. Among the 32 patients without surgery or in whom the appendix was not removed at laparotomy, the recurrence rate was 3%. No malignancy was found at colonic radiography in 84 conservatively treated patients. Based on these findings, the following strategy is recommended for management of appendiceal abscess. 1) Initially conservative treatment, with surgical intervention if this fails. 2) 'Interval' elective appendectomy not routinely undertaken. 3) For patients older than 40, follow-up with colonic radiography, possibly colonoscopy and, if necessary, also exploratory laparotomy to exclude intraabdominal malignancy.
回顾了14年间193例阑尾脓肿患者的情况。98例患者接受非手术治疗，并发症发生率为3%。95例接受手术治疗的患者并发症发生率为32%。1例患者死亡。80例行“间隔期”择期阑尾切除术，并发症发生率为23%。32例未接受手术或开腹时未切除阑尾的患者中，复发率为3%。84例接受保守治疗的患者结肠造影未发现恶性病变。基于这些发现，建议对阑尾脓肿采用以下治疗策略。1）初始采用保守治疗，若失败则进行手术干预。2）不常规进行“间隔期”择期阑尾切除术。3）对于40岁以上患者，采用结肠造影随访，可能还需进行结肠镜检查，必要时进行剖腹探查以排除腹内恶性肿瘤。
