Department of Clinical Pharmacy, Wendeng Hospital of Traditional Chinese Orthopedics and Traumatology of Shandong Province, No.1 Fengshan Road, Wendeng District, Weihai City, 264400, Shandong Province, China.
BMC Surg. 2023 Jul 24;23(1):208. doi: 10.1186/s12893-023-02108-1.
This meta-analysis aimed to compare the efficacy and safety of antibiotic treatment and appendectomy for acute uncomplicated appendicitis.
We searched the randomized controlled studies (RCTs) comparing appendectomy with antibiotic treatment for uncomplicated acute appendicitis in the electronic database including Pubmed, Embase, Cochrane, Web of Science, CNKI, VIP, and WanFang. The primary outcomes included complication-free treatment success at 1 year, complications, surgical complications, and the complicated appendicitis rates. Secondary outcomes included negative appendicitis, length of hospital stay, the quality of life at 1 month, and the impact of an appendicolith on antibiotic therapy.
Twelve randomized controlled studies were included. Compared with surgery group, the antibiotic group decreased the complication-free treatment success at 1 year (RR 0.81; 95% CI 0.73-0.91; z = 3.65; p = 0.000). Statistically significance was existed between antibiotic group and surgical group with both surgical types(open and laparoscopic) (RR 0.43; 95% CI 0.31-0.58; z = 5.36; p = 0.000), while no between the antibiotic treatment and laparoscopic surgery (RR 0.72; 95% CI 0.41-1.24; z = 1.19; p = 0.236). There was no statistically significant differences between two groups of surgical complications (RR 1.38; 95% CI 0.70-2.73; z = 0.93; p = 0.353), the complicated appendicitis rate (RR 0.71; 95% CI 0.36-1.42; z = 0.96; p = 0.338), negative appendectomy rate (RR 1.11; 95% CI 0.69-1.79; z = 0.43; p = 0.670), duration of hospital stay (SMD 0.08; 95%CI -0.11-0.27; z = 0.80; p = 0.422), and quality of life at 1 month (SMD 0.09; 95%CI -0.03-0.20; z = 1.53; p = 0.127). However, in the antibiotic treatment group, appendicolith rates were statistically higher in those whose symptoms did not improve (RR 2.94; 95% CI 1.28-6.74; z = 2.55; p = 0.011).
Although the cure rate of antibiotics is lower than surgery, antibiotic treatment is still a reasonable option for patients with uncomplicated acute appendicitis who do not want surgery without having to worry about complications or complicating the original illness.
本荟萃分析旨在比较抗生素治疗和阑尾切除术治疗急性单纯性阑尾炎的疗效和安全性。
我们在电子数据库中检索了比较阑尾切除术和抗生素治疗单纯性急性阑尾炎的随机对照研究（RCT），包括 Pubmed、Embase、Cochrane、Web of Science、CNKI、VIP 和 WanFang。主要结局包括 1 年时无并发症的治疗成功率、并发症、手术并发症和复杂阑尾炎发生率。次要结局包括阴性阑尾切除术、住院时间、1 个月时的生活质量以及阑尾结石对抗生素治疗的影响。
纳入了 12 项随机对照研究。与手术组相比，抗生素组 1 年时无并发症的治疗成功率降低（RR 0.81；95%CI 0.73-0.91；z=3.65；p=0.000）。抗生素组与手术组（开放和腹腔镜）的所有手术类型之间均存在统计学意义（RR 0.43；95%CI 0.31-0.58；z=5.36；p=0.000），而抗生素治疗与腹腔镜手术之间则没有统计学意义（RR 0.72；95%CI 0.41-1.24；z=1.19；p=0.236）。两组手术并发症发生率（RR 1.38；95%CI 0.70-2.73；z=0.93；p=0.353）、复杂阑尾炎发生率（RR 0.71；95%CI 0.36-1.42；z=0.96；p=0.338）、阴性阑尾切除术率（RR 1.11；95%CI 0.69-1.79；z=0.43；p=0.670）、住院时间（SMD 0.08；95%CI -0.11-0.27；z=0.80；p=0.422）和 1 个月时的生活质量（SMD 0.09；95%CI -0.03-0.20；z=1.53；p=0.127）均无统计学差异。然而，在抗生素治疗组中，对于症状未改善的患者，阑尾结石发生率较高（RR 2.94；95%CI 1.28-6.74；z=2.55；p=0.011）。
尽管抗生素治疗的治愈率低于手术，但对于不愿手术且无需担心并发症或使原有疾病复杂化的单纯性急性阑尾炎患者，抗生素治疗仍然是一种合理的选择。
