Release date: 2015-06-24
For a long time, appendectomy has been the standard treatment for acute appendicitis and has become one of the first operations surgeons in all countries. But on June 16, the latest issue of the Journal of the American Medical Association (JAMA) said that more than 70% of patients with acute uncomplicated appendicitis can be treated with antibiotics instead of appendectomy.
The trial, published by JAMA, was launched in 2009 and included 530 patients with acute noncomplex appendicitis who were 18 to 60 years old and confirmed by CT scan. The patients were randomly assigned to the surgery group and the antibiotic treatment group, and were followed up for 1 year after discharge. The antibiotic treatment group received a 3-day intravenous ertapenem (1 g/d) followed by oral levofloxacin (500 mg, qd) and metronidazole (500 mg, tid) for 7 days.
It was found that only one of the 273 patients in the surgical treatment group failed surgery and the success rate was 99.6%. Of the 257 patients in the antibiotic-treated group, 73% did not require surgery, and 70 (27%) underwent appendectomy for 1 year of follow-up and 1 was lost to follow-up.
Of the 70 people who underwent surgery, 83% were uncomplicated appendicitis, 10% developed complex appendicitis (abscess around the appendix, gangrene, etc.), and 7% were cured after treatment. However, it is suspected that appendicitis may recur and the appendix was removed. Compared with the surgery group, these patients delayed the operation time, but did not have serious complications such as abdominal abscess.
The team believes that for acute non-complex appendicitis diagnosed by CT, the antibiotic treatment effect is not better than appendectomy (the latter is nearly 100% cured), but nearly 80% of patients can be discharged by medication (7% of them) Suffering from recurrence and surgery.)
"Now we know that only a small number of patients with appendicitis need urgent surgery. Even those who need surgery after the medication, the delay in the operation does not bring a bad ending." Research leader, Turku University, Finland Hospital doctor Salminen said.
In fact, appendectomy established its "golden status" from 1886. Surgeon Fitz found through a large number of autopsy that appendicitis from the initial mild mucosal lesions to transmural lesions can eventually cause gangrene-like lesions and pelvic abscesses - - After that, resection has become a principle treatment for appendicitis.
However, what has been overlooked by history is that the report came from an era without antibiotics. In the 1950s, doctors found that treatment of appendicitis with antibiotics also achieved certain effects, but the results did not attract academic attention because of the inability to go beyond surgery. However, in recent years, more and more people have begun to pay attention to the conservative treatment of appendicitis. In May 2014, a meta-analysis published by Zhongshan Hospital affiliated to Fudan University found that there was no statistical difference between conservative treatment and surgical treatment for acute uncomplicated appendicitis, and conservative treatment was superior to surgery in terms of complications. : 0.46, 95% CI: 0.32 - 0.67).
JAMA Associate Editor, Dr. Edward Livingston said: "Even if surgical resection is still the ultimate choice, the treatment guidelines for appendicitis should be revised. CT imaging technology makes accurate diagnosis possible, while the new antibiotic spectrum covers appendicitis and The pathogenic bodies of various serious complications are enough to change the history of treatment of the disease."
“A hundred years of surgery have helped countless patients. But with accurate diagnosis and the development of antibiotics, appendectomy may no longer be necessary for the main type of clinical appendicitis – uncomplicated appendicitis. It’s gone."
It should be noted that patients with complex appendicitis, children, and women – patients in these cases are not included in the study group and therefore do not apply.
Source: Medical Journal
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