Efficacy and Safety of Nonoperative Treatment for Acute Appendicitis: A Meta-analysis
Efficacy and Safety of Nonoperative Treatment for Acute Appendicitis: A Meta-analysis
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DOI：
10.1542/peds.2016-3003
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发表时间：
2017-03-01
期刊：
影响因子：
8
通讯作者：
Hall, Nigel J.
中科院分区：
文献类型：
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作者：
Georgiou, Roxani;Eaton, Simon;Hall, Nigel J.
背景：非手术治疗（NOT）与抗生素单独急性无并发症阑尾炎（AUA）的儿童已被提出作为一种替代appendectomy.Objective：以确定安全性和有效性的基础上，目前的文献。数据源：三个电子数据库。研究选择：所有报道儿童不接受AUA治疗的文章。数据提取：两名评价者独立验证研究纳入和提取数据。结果：包括10篇报道413名儿童接受不接受AUA治疗的文章。6项，包括1项随机对照试验，与非阑尾切除术进行比较。其余4例报告了未接受非对照组治疗的儿童的结局。在97%的儿童中，NOT作为初始治疗有效（95%置信区间[CI] 96%至99%）。接受阑尾切除术治疗的儿童的初始住院时间短于未接受阑尾切除术治疗的儿童（平均差异0.5天[95% CI 0.2 - 0.8]; P = 0.002）。在最终报告的随访（范围8周至4年）时，82%的儿童（95% CI 77%至87%）未保持有效（未进行阑尾切除术）。复发性阑尾炎发生率为14%（95% CI 7%-21%）。随访期间，NOT和阑尾切除术的并发症和总住院时间相似。没有严重的不良事件相关的NOT were reported. LIMITED：缺乏前瞻性随机研究限制了明确的结论，影响临床practice.CONCLUSIONS：目前的数据表明，NOT是安全的。在97%的AUA儿童中，它作为初始治疗有效，阑尾炎复发率为14%。与阑尾切除术相比，NOT的长期临床结局和成本效益需要进一步评估，最好是在大型随机试验中，以可靠地告知决策。
CONTEXT: Nonoperative treatment (NOT) with antibiotics alone of acute uncomplicated appendicitis (AUA) in children has been proposed as an alternative to appendectomy.OBJECTIVE: To determine safety and efficacy of NOT based on current literature. DATASOURCES: Three electronic databases.STUDY SELECTION: All articles reporting NOT for AUA in children.DATA EXTRACTION: Two reviewers independently verified study inclusion and extracted data.RESULTS: Ten articles reporting 413 children receiving NOT were included. Six, including 1 randomized controlled trial, compared NOT with appendectomy. The remaining 4 reported outcomes of children receiving NOT without a comparison group. NOT was effective as the initial treatment in 97% of children (95% confidence interval [CI] 96% to 99%). Initial length of hospital stay was shorter in children treated with appendectomy compared with NOT (mean difference 0.5 days [95% CI 0.2 to 0.8]; P =.002). At final reported follow-up (range 8 weeks to 4 years), NOT remained effective (no appendectomy performed) in 82% of children (95% CI 77% to 87%). Recurrent appendicitis occurred in 14% (95% CI 7% to 21%). Complications and total length of hospital stay during follow-up were similar for NOT and appendectomy. No serious adverse events related to NOT were reported.LIMITATIONS: The lack of prospective randomized studies limits definitive conclusions to influence clinical practice.CONCLUSIONS: Current data suggest that NOT is safe. It appears effective as initial treatment in 97% of children with AUA, and the rate of recurrent appendicitis is 14%. Longer-term clinical outcomes and cost-effectiveness of NOT compared with appendicectomy require further evaluation, preferably in large randomized trials, to reliably inform decision-making.