Pediatrics:提到“阑尾炎”就想到“阑尾切除”,对儿童来说,这算不算过度治疗呢?

2022-05-17 liangying 网络

阑尾切除依然是阑尾炎治疗的最佳手段。

虽然穿孔性阑尾炎可以通过静脉注射抗生素和阑尾切除术来治疗,但目前非穿孔性阑尾炎的治疗标准是也是立即行腹腔镜阑尾切除术。在过去的十年里,越来越多的证据对这种常规做法提出了质疑。

成人随机对照试验的结果表明,仅使用抗生素的非手术治疗(NOM)可能是一种合理的治疗方法,尽管多达39%的患者可能会在5年内经历治疗失败。最近公布的两项小型前瞻性儿科研究的长期随访数据显示,NOM的5年成功率为58%至70%。

在本研究中,研究者们查询了儿科健康信息系统数据库,以确定年龄小于19岁的儿童是否有阑尾炎诊断代码。使用线性趋势分析来评估非穿孔性阑尾炎患儿NOM的后续应用和结果,计算了治疗失败的儿童比例——定义为后续还是进行了阑尾切除术或住院治疗,诊断代码为穿孔性阑尾炎。

在9年的研究期间,共确定了117705名患有阑尾炎的儿童。在73544例非穿孔性阑尾炎患儿中,10394例(14.1%)接受了NOM。NOM的几率显著增加,1年和5年的失败率分别为18.6%和23.3%。NOM失败的儿童在失败时的穿孔率高于初次出现时的一般队列(45.7%vs37.5%,P<0.001)。在12个月的随访期内,接受NOM治疗的患者后续相关急诊就诊率(8.0%vs5.1%,P<0.001)和住院率(4.2%vs1.4%,P<0.001)较高。

非手术治疗的10409例非穿孔性阑尾炎患儿的无事件生存率(无治疗失败)。(A) 索引访问后14天内出现故障的时间。(B) 指数访视后5年内的失败时间

儿童非穿孔性阑尾炎的NOM正在增加。虽然大多数接受NOM治疗的儿童在数年后仍无复发,但他们在复发时有很大的穿孔风险,并且可能比立即行阑尾切除术的儿童发生术后并发症的几率更高。

参考文献:Lipsett SC, Monuteaux MC, Shanahan KH, et al. Nonoperative Management of Uncomplicated Appendicitis. Pediatrics. 2022;149(5):e2021054693

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    2022-11-24 hbwxf
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    2022-08-02 feather89
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    2022-06-27 xiaohuan0811

    值得学习,希望以后多多推送

    0

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    2022-05-17 赛华佗

    #阑尾炎#抗生素治疗可能不劣于手术本身

    0

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