Lee Hyun Gu, Park In Ja
Department of Surgery, Kyung Hee Universitiy Hospital at Gangdong, Kyung Hee Universtiy College of Medicine, Seoul, Korea.
Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ann Coloproctol. 2025 Apr;41(2):107-118. doi: 10.3393/ac.2023.00192.0027. Epub 2025 Apr 16.
Appendectomy as the standard treatment for acute appendicitis has been challenged by accumulating evidence supporting nonoperative management with antibiotics as a potential primary treatment. This review aimed to summarize the clinical outcomes and the optimal indications for nonoperative management of acute appendicitis in adults. Current evidence suggests that uncomplicated and complicated appendicitis have different pathophysiologies and should be treated differently. Nonoperative management for uncomplicated appendicitis was not inferior to appendectomy in terms of complications and length of stay, with less than a 30% failure rate at 1 year. The risk of perforation and postoperative complications did not increase even if nonoperative management failed. Complicated appendicitis with localized abscess or phlegmon could also be treated conservatively, with a success rate of more than 80%. An interval appendectomy following successful nonoperative management is recommended only for patients over the age of 40 years to exclude appendiceal malignancy. The presence of appendicoliths increased the risk of treatment failure and complications; thus, it may be an indication for appendectomy. Nonoperative management is a safe and feasible option for both uncomplicated and complicated appendicitis. Patients should be informed that nonoperative management may be a safe alternative to surgery, with the possibility of treatment failure.
作为急性阑尾炎标准治疗方法的阑尾切除术，受到了越来越多支持使用抗生素进行非手术治疗作为潜在主要治疗方法的证据的挑战。本综述旨在总结成人急性阑尾炎非手术治疗的临床结果和最佳适应证。目前的证据表明，单纯性阑尾炎和复杂性阑尾炎具有不同的病理生理学，应采用不同的治疗方法。在并发症和住院时间方面，单纯性阑尾炎的非手术治疗并不逊色于阑尾切除术，1年时失败率低于30%。即使非手术治疗失败，穿孔风险和术后并发症也不会增加。伴有局限性脓肿或蜂窝织炎的复杂性阑尾炎也可采用保守治疗，成功率超过80%。仅建议40岁以上成功接受非手术治疗的患者进行间隔期阑尾切除术，以排除阑尾恶性肿瘤。阑尾结石的存在增加了治疗失败和并发症的风险；因此，它可能是阑尾切除术的一个指征。非手术治疗对于单纯性和复杂性阑尾炎都是一种安全可行的选择。应告知患者，非手术治疗可能是一种安全的手术替代方法，但存在治疗失败的可能性。
