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BMJ:抗生素治疗阑尾炎应受重视

来源:新华网 2012-05-04 21:51

听见阑尾炎三个字,人们马上想到的是手术切除,但英国一项最新研究说,不是所有的阑尾炎患者都要手术,对许多只有简单发炎症状的患者来说,也可以采用抗生素治疗,这与手术相比不仅方便,在抗感染方面还有优势。

英国诺丁汉大学医院等机构研究人员在新一期《英国医学杂志》(BMJ)上报告说,他们综合分析了过去多项研究中900名阑尾炎患者的资料,其中约一半人接受了手术,而另一半人采取了抗生素治疗。

结果显示,用抗生素治疗阑尾炎的效果也不错,63%的患者都能治愈,也就是说,实际上约三分之二的患者都不需要手术。此外,由于手术开刀还有额外的感染风险,用抗生素治疗在抗感染方面还具备优势。

进行研究的迪利普·洛博教授说,由于相当大一部分的患者群体都能使用抗生素治疗,人们有必要考虑把抗生素作为治疗阑尾炎的一种主要方式,而不是一提起阑尾炎就要手术。这不仅对患者方便,还有助节约医疗资源。

不过他也提醒说,适用抗生素治疗的主要是只有简单发炎症状的患者,如果还有穿孔、坏疽等并发症,还是应该考虑手术治疗。此外,部分接受抗生素治疗的患者后来出现了复发症状,在决定治疗方式的时候,这也应是考虑因素之一。(生物谷Bioon.com)

Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials

Varadhan, Krishna K; Neal, Keith R; Lobo, Dileep N

Objective To compare the safety and efficacy of antibiotic treatment versus appendicectomy for the primary treatment of uncomplicated acute appendicitis. Design Meta-analysis of randomised controlled trials. Population Randomised controlled trials of adult patients presenting with uncomplicated acute appendicitis, diagnosed by haematological and radiological investigations. Interventions Antibiotic treatment versus appendicectomy. Outcome measures The primary outcome measure was complications. The secondary outcome measures were efficacy of treatment, length of stay, and incidence of complicated appendicitis and readmissions. Results Four randomised controlled trials with a total of 900 patients (470 antibiotic treatment, 430 appendicectomy) met the inclusion criteria. Antibiotic treatment was associated with a 63% (277/438) success rate at one year. Meta-analysis of complications showed a relative risk reduction of 31% for antibiotic treatment compared with appendicectomy (risk ratio (Mantel-Haenszel, fixed) 0.69 (95% confidence interval 0.54 to 0.89); I2=0%; P=0.004). A secondary analysis, excluding the study with crossover of patients between the two interventions after randomisation, showed a significant relative risk reduction of 39% for antibiotic therapy (risk ratio 0.61 (0.40 to 0.92); I2=0%; P=0.02). Of the 65 (20%) patients who had appendicectomy after readmission, nine had perforated appendicitis and four had gangrenous appendicitis. No significant differences were seen for treatment efficacy, length of stay, or risk of developing complicated appendicitis. Conclusion Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis.

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