Reis Wolfertstetter Patricia, Ebert John Blanford, Barop Judith, Denzinger Markus, Kertai Michael, Schlitt Hans J, Knorr Christian
Faculty of Medicine, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
Department of Psychiatry and Psychotherapy, Medbo Bezirksklinikum Regensburg, Universitaetsstrasse 84, 93053 Regensburg, Germany.
Children (Basel). 2024 Mar 13;11(3):340. doi: 10.3390/children11030340.
Simple appendicitis may be self-limiting or require antibiotic treatment or appendectomy. The aim of this study was to assess the feasibility and safety of a nonoperative, antibiotic-free approach for suspected simple appendicitis in children.
This single-center, retrospective study included patients (0-17 years old) who were hospitalized at the pediatric surgery department due to suspected appendicitis between 2011 and 2012. Data from patients who primarily underwent appendectomy were used as controls. The follow-up of nonoperatively managed patients was conducted in 2014. The main outcome of interest was appendicitis recurrence.
A total of 365 patients were included: 226 were treated conservatively and 139 underwent appendectomy. Fourteen (6.2% of 226) of the primarily nonoperatively treated patients required secondary appendectomy during follow-up, and histology confirmed simple, uncomplicated appendicitis in 10 (4.4% of 226) patients. Among a subset of 53 patients managed nonoperatively with available Alvarado and/or Pediatric Appendicitis Scores and sonographic appendix diameters in clinical reports, 29 met the criteria for a high probability of appendicitis. Three of these patients (10.3% of 29) underwent secondary appendectomy. No complications were reported during follow-up.
A conservative, antibiotic-free approach may be considered for pediatric patients with suspected uncomplicated appendicitis in a hospital setting. Only between 6 and 10% of these patients required secondary appendectomy. Nevertheless, the cohort of patients treated nonoperatively was likely to have also included individuals with further abdominal conditions other than appendicitis. Active observation and clinical support during the disease course may help patients avoid unnecessary procedures and contribute to spontaneous resolution of appendicitis or other pediatric conditions as the cause of abdominal pain. However, further studies are needed to define validated diagnostic and management criteria.
单纯性阑尾炎可能会自行缓解，或需要抗生素治疗或阑尾切除术。本研究的目的是评估一种针对疑似儿童单纯性阑尾炎的非手术、无抗生素治疗方法的可行性和安全性。
这项单中心回顾性研究纳入了2011年至2012年间因疑似阑尾炎在小儿外科住院的患者（0至17岁）。主要接受阑尾切除术的患者数据用作对照。2014年对非手术治疗患者进行了随访。主要关注的结果是阑尾炎复发。
共纳入365例患者：226例接受了保守治疗，139例接受了阑尾切除术。14例（226例中的6.2%）最初接受非手术治疗的患者在随访期间需要二次阑尾切除术，组织学检查证实10例（226例中的4.4%）患者为单纯性、无并发症的阑尾炎。在53例非手术治疗的患者子集中，临床报告中有可用的阿尔瓦拉多（Alvarado）和/或小儿阑尾炎评分以及超声阑尾直径，其中29例符合阑尾炎高概率标准。这些患者中有3例（29例中的10.3%）接受了二次阑尾切除术。随访期间未报告并发症。
对于医院环境中疑似无并发症阑尾炎的儿科患者，可考虑采用保守、无抗生素的治疗方法。这些患者中只有6%至10%需要二次阑尾切除术。然而，非手术治疗的患者队列可能还包括除阑尾炎外有其他腹部疾病的个体。疾病过程中的积极观察和临床支持可能有助于患者避免不必要的手术，并有助于阑尾炎或其他引起腹痛的儿科疾病的自发缓解。然而，需要进一步研究来确定有效的诊断和管理标准。
