北京大学学报(医学版) ›› 2014, Vol. 46 ›› Issue (5): 715-719.

• 论著 • 上一篇    下一篇

应用抗生素治疗急性单纯性阑尾炎的策略及其价值

赵轶国△,印建中   

  1. (北京大学第一医院普通外科, 北京100034)
  • 出版日期:2014-10-18 发布日期:2014-10-18

Treatment with antibiotics for uncomplicated acute appendicitis: strategy and its value

ZHAO Yi-guo△, YIN Jian-zhong   

  1. (Department of Surgery, Peking University First Hospital, Beijing 100034, China)
  • Online:2014-10-18 Published:2014-10-18

摘要: 目的:确立急性单纯性阑尾炎的临床特点,评价抗生素在治疗急性单纯性阑尾炎中的作用。方法: 回顾分析北京大学第一医院10年间手术切除的742例成人急性阑尾炎病例,依据病理报告,通过统计学分析确立临床上判定急性单纯性阑尾炎的方法。应用此方法纳入46例急性单纯性阑尾炎病例,予以头孢三代+甲硝唑保守治疗至少48 h,并随访6个月,与相同条件下行手术切除的病例进行对照研究,评价治疗效果。结果:根据统计学结果将入院时白细胞计数低于20×109/L、查体未触及腹肌紧张、B超或CT未发现阑尾内存在粪石嵌顿,阑尾周围无积液以及腹腔内无游离气体作为临床上急性单纯性阑尾炎的纳入标准。在46例急性单纯性阑尾炎患者中,44例(95.65%)经抗生素保守治疗缓解,平均腹痛缓解时间为1.6 d,2例经药物治疗无效而转行手术切除,术后病理证实阑尾坏疽或化脓。行抗生素保守治疗的患者和行手术切除的患者在腹痛缓解时间和总住院时间上差异无统计学意义。经保守治疗缓解的44例急性单纯性阑尾炎患者,5例(11.36%)6个月内再次发作急性阑尾炎。结论: 尽管有一定复发率,绝大多数急性单纯性阑尾炎均可经抗生素保守治疗获得较好缓解;在决定使用抗生素保守治疗之前应当对患者进行合理筛选。

关键词: 抗菌药, 阑尾炎, 阑尾切除术

Abstract: Objective:To establish the characteristics of uncomplicated acute appendicitis (UAA) and assess the efficacy of antibiotics by comparison with emergency appendicectomy for treatment. Methods: A retrospective clinical analysis was made on 742 cases of acute appendicitis. Several characteristics of UAA were identified. Following these rules 46 UAA patients were enrolled to receive antibiotic treatment for at least 48 h.Follow-up was carried out for 6 months.Results: Statistical analysis indicated that high level white blood cell count (>20×109/L,P=0.000, OR=2.717), local or diffuse muscle guarding (P=0.031, OR=1.649), intraluminal stercolith (P=0.000, OR=2.939) and periappendiceal fluid (P=0.005, OR=3.273) were independent risk factors of complicated acute appendicitis. With none of these factors we enrolled 46 UAA patients. Of the 46 patients, 44(95.65%) were treated successfully with antibiotics. 2(4.35%) patients were unexpectedly identified to have complicated appendicitis at surgery. Recurrent appendicitis occurred in 5(11.36%) patients after 6 months. There was no difference in duration of pain and duration of hospital stay between antibiotic treatment group and appendicectomy group. Conclusion: Although antibiotic treatment may fail in some UAA cases, and there is a risk of recurrence, antibiotic treatment still appears to be a safe firstline therapy for UAA patients.

Key words: Anti-bacterial agents, Appendicitis, Appendectomy

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