Comparison of Antibiotic Therapy and Appendectomy for Acute Uncomplicated Appendicitis in Children A Meta-analysis
Comparison of Antibiotic Therapy and Appendectomy for Acute Uncomplicated Appendicitis in Children A Meta-analysis
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DOI：
10.1001/jamapediatrics.2017.0057
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发表时间：
2017-05-01
期刊：
影响因子：
26.1
通讯作者：
Zhou, Zongguang
中科院分区：
文献类型：
--
作者：
Huang, Libin;Yin, Yuan;Zhou, Zongguang
重要性：抗生素治疗急性无并发症阑尾炎对成人患者有效，但其在儿童患者中的应用仍存在争议。目的比较抗生素治疗与阑尾切除术作为儿科急性无并发症阑尾炎的主要治疗方法的安全性和有效性。截止2016年4月17日，检索PubMed、MEDLINE、EMBASE和Cochrane图书馆数据库以及Cochrane对照试验注册库中随机临床试验。这项研究仅限于用英语发表的研究。搜索词包括阑尾炎、抗生素、阑尾切除术、随机对照试验、对照临床试验、随机、安慰剂、药物治疗、随机和试验。研究选择meta分析包括比较抗生素治疗与阑尾切除术治疗儿科（5-18岁）急性无并发症阑尾炎的随机临床试验和前瞻性临床对照试验。结果包括以下至少2项：抗生素治疗和阑尾切除术的成功率、并发症、再入院、住院时间、总费用和残疾天数。数据提取和综合数据由2位审稿人独立提取。纳入研究的质量按照Cochrane指南和Newcastle-Ottawa标准进行检查。使用logistic固定效应模型对数据进行汇总，并估计有或没有阑尾石的亚组汇总风险比。主要结局和测量主要结局为治疗成功率。假设是在数据收集之前制定的。结果共筛选到527篇文献。在5项独特的研究中，纳入了404例独特的无并发症阑尾炎患者（5-15岁）。168例患者中有152例（90.5%）非手术治疗成功，Mantel-Haenszel固定效应风险比为8.92 （95% CI, 2.67-29.79；异质性，P= 0.99; I-2= 0%）。亚组分析显示，阑尾结石患者治疗失败的风险增加，Mantel-Haenszel固定效应风险比为10.43 （95% CI, 1.46 ~ 74.26；异质性，P = 0.91; I-2 = 0%）。结论和相关性本荟萃分析显示，抗生素作为儿科无并发症阑尾炎患者的初始治疗可能是可行和有效的，且不会增加并发症的风险。然而，失败率，主要是由于阑尾结石的存在，是高于阑尾切除术。对于无并发症的阑尾炎伴阑尾结石，最好建议手术治疗。
IMPORTANCE Antibiotic therapy for acute uncomplicated appendicitis is effective in adult patients, but its application in pediatric patients remains controversial.OBJECTIVE To compare the safety and efficacy of antibiotic treatment vs appendectomy as the primary therapy for acute uncomplicated appendicitis in pediatric patients.DATA SOURCES The PubMed, MEDLINE, EMBASE, and Cochrane Library databases and the Cochrane Controlled Trials Register for randomized clinical trials were searched through April 17, 2016. The search was limited to studies published in English. Search terms included appendicitis, antibiotics, appendectomy, randomized controlled trial, controlled clinical trial, randomized, placebo, drug therapy, randomly, and trial.STUDY SELECTION Randomized clinical trials and prospective clinical controlled trials comparing antibiotic therapy with appendectomy for acute uncomplicated appendicitis in pediatric patients (aged 5-18 years) were included in the meta-analysis. The outcomes included at least 2 of the following terms: success rate of antibiotic treatment and appendectomy, complications, readmissions, length of stay, total cost, and disability days. DATAEXTRACTION AND SYNTHESIS Data ere independently extracted by 2 reviewers. The quality of the included studies was examined in accordance with the Cochrane guidelines and the Newcastle-Ottawa criteria. Data were pooled using a logistic fixed-effects model, and the subgroup pooled risk ratio with or without appendicolith was estimated.MAIN OUTCOMES AND MEASURES The primary outcome was the success rate of treatment. The hypothesis was formulated before data collection. RESULTS A total of 527 articles were screened. In 5 unique studies, 404 unique patients with uncomplicated appendicitis (aged 5-15 years) were enrolled. Nonoperative treatment was successful in 152 of 168 patients (90.5%), with a Mantel-Haenszel fixed-effects risk ratio of 8.92 (95% CI, 2.67-29.79; heterogeneity, P=.99; I-2= 0%). Subgroup analysis showed that the risk for treatment failure in patients with appendicolith increased, with a Mantel-Haenszel fixed-effects risk ratio of 10.43 (95% CI, 1.46-74.26; heterogeneity, P =.91; I-2 = 0%).CONCLUSIONS AND RELEVANCE This meta-analysis shows that antibiotics as the initial treatment for pediatric patients with uncomplicated appendicitis may be feasible and effective without increasing the risk for complications. However, the failure rate, mainly caused by the presence of appendicolith, is higher than for appendectomy. Surgery is preferably suggested for uncomplicated appendicitis with appendicolith.