Predictive Factors for Negative Outcomes in Initial Non-operative Management of Suspected Appendicitis
Predictive Factors for Negative Outcomes in Initial Non-operative Management of Suspected Appendicitis
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DOI：
10.1007/s11605-009-1094-1
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发表时间：
2010-02-01
影响因子：
3.2
通讯作者：
Hiramatsu, Takeyuki
中科院分区：
文献类型：
--
作者：
Shindoh, Junichi;Niwa, Hirotaka;Hiramatsu, Takeyuki
据报道，急性阑尾炎的非手术治疗成功率较高。然而，阴性结果的危险因素尚未确定。我们回顾了380名因疑似阑尾炎而接受初步治疗的患者。分为三组：手术组、非手术治疗成功组(成功组)和需要手术中转治疗组(失败组)。比较两组患者的术前临床资料，调查阴性结果的危险因素。13名患者因非手术治疗禁忌症而被排除在外。在剩余的367名患者中，143名患者(39.0%)接受了手术治疗，224名患者(61.0%)接受了抗生素治疗。在224例患者中，91例(40.6%)对抗生素耐药，用药超过24小时后中转手术。多因素分析显示，C反应蛋白水平升高(>；4 mg/dL)和阑尾结石的存在是转换的显著危险因素。手术组和失败组的并发症发生率无显著差异。在非手术治疗中，升高的C反应蛋白浓度和阑尾结石可能预示着不良结局。然而，在使用抗生素的情况下，立即阑尾切除术至少可以避免24小时，而不会增加并发症。
Acute appendicitis has been reported to be managed with non-operative therapy at relatively high successful rate. However, risk factors for negative outcome have not been established.Three hundred eighty consecutive patients who underwent initial therapy for suspected appendicitis were reviewed. They were divided into three groups: operation group, the group successfully managed with non-operative therapy (success group), and the group required surgical conversion (failure group). Preoperative clinical data were compared among the groups and risk factors for negative outcomes were investigated.Thirteen patients were excluded due to contraindication for non-operative therapy. Of the remaining 367 patients, 143 patients (39.0%) were primarily treated with surgery, and 224 patients (61.0%) were initially managed with antibiotics. Among the 224 patients, 91 patients (40.6%) were refractory to antibiotics and converted to surgery after more than 24 h usage of antibiotics. Multivariate analysis revealed that elevated C-reactive protein (CRP) level (> 4 mg/dL) and presence of appendicolith were significant risk factors for conversion. Morbidity rate showed no significant difference between the operative and failure groups.Elevated CRP concentration and appendicolith may predict the negative outcome in non-operative management. However, immediate appendectomy can possibly be avoided at least 24 h without increasing morbidity under the usage of antibiotics.