Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Surgery. 2021 Jul;170(1):215-221. doi: 10.1016/j.surg.2021.02.066. Epub 2021 Apr 6.
A previous report proposed ultrasonography-based classification as a promising means of predicting pediatric spontaneously resolving appendicitis. The present study investigated the long-term prognosis of supportive care for low-grade appendicitis identified by ultrasonography, defined as an appendix with a smooth submucosal layer irrespective of blood flow or an appendix with an irregular layer and increased blood flow.
The present, retrospective cohort study enrolled patients under 16 years of age with acute appendicitis at a children's hospital between October 2010 and September 2016. The inclusion criteria were ultrasonography findings showing an appendix with (1) full visualization, (2) a diameter ≥6 mm, (3) a smooth submucosal layer or an irregular layer with increased blood flow, and (4) no appendiceal mass, abscess, or perforation. The exclusion criteria were: (1) a history of acute appendicitis, (2) antibiotic administration within 72 hours before diagnosis, and (3) antibiotic administration or surgery before supportive care. The primary outcome was the event-free duration, defined as a period of supportive care alone with no additional intervention or recurrence of appendicitis.
One hundred and eighty-two patients were enrolled. The median Alvarado score was 7 (interquartile range, 6-8), and the median follow-up duration in event-free cases was 1,922 days (interquartile range, 1,347-2,614 days). The event-free rate was 75.0%, 67.0%, and 62.5%, at 1, 2, and 5 years, respectively.
The long-term, event-free rate exceeded 60% in patients with low-grade appendicitis defined by ultrasonography who received neither surgery nor antibiotic treatment. Most recurrences occurred within 2 years of the initial diagnosis.
先前有报道提出，基于超声的分类方法有望成为预测小儿自限性阑尾炎的一种有前途的手段。本研究调查了超声检查确定的低级别阑尾炎的支持性治疗的长期预后，低级别阑尾炎定义为阑尾黏膜下层光滑，无论血流情况如何，或阑尾黏膜不规则且血流增加。
本回顾性队列研究纳入了 2010 年 10 月至 2016 年 9 月在一家儿童医院就诊的年龄在 16 岁以下的急性阑尾炎患者。纳入标准为超声检查结果显示阑尾（1）完全可见，（2）直径≥6mm，（3）黏膜下层光滑或不规则且血流增加，（4）无阑尾肿块、脓肿或穿孔。排除标准为：（1）有急性阑尾炎病史，（2）诊断前 72 小时内使用过抗生素，（3）在支持性治疗前使用过抗生素或手术。主要结局是无事件持续时间，定义为仅接受支持性治疗而无其他干预或阑尾炎复发的时间。
共纳入 182 例患者。Alvarado 评分中位数为 7（四分位距，6-8），无事件病例的中位随访时间为 1922 天（四分位距，1347-2614 天）。1、2 和 5 年的无事件生存率分别为 75.0%、67.0%和 62.5%。
超声检查定义的低级别阑尾炎患者既未接受手术也未接受抗生素治疗，其长期无事件生存率超过 60%。大多数复发发生在初始诊断后的 2 年内。
