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急性单纯性阑尾炎的治疗
Treatment of Acute Uncomplicated Appendicitis


David A. Talan ... 其他 • 2021.09.16
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• 抗生素和阑尾切除术治疗阑尾炎的随机比较试验 • 抗生素是不劣于阑尾切除术的急性阑尾炎治疗方法 • 阑尾炎非手术疗法是一个可行的选择

急性阑尾炎的治疗

 

李俊†,孙益红‡

†上海国际嘉会医院普外科;‡复旦大学附属中山医院普外科

 

急性阑尾炎是急诊腹部手术的最常见原因,其终身风险为7%~8%。未经治疗的阑尾炎如果发生破裂,有可能导致脓肿、腹膜炎、脓毒症和死亡。传统上,所有急性阑尾炎都采用急诊阑尾切除术治疗。然而近三十年间,多项临床研究提示了急性单纯性阑尾炎非手术治疗的有效性和安全性。

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本刊的这一栏目首先提供一份强调某一常见临床问题的病例摘要,然后提出支持各种策略的证据。如果有正式指南,作者接下来会对其进行综述。文章以作者的临床建议结尾。

 

既往体健的28岁女性因腹痛2天到急诊科就诊,腹痛始于脐区并转移至右下腹。患者是远程工作的单身母亲,抚养一个5岁孩子。体温为37.8℃;其他生命体征正常。在1~10分的疼痛量表上(10分代表最严重疼痛),她将其疼痛评定为7分。检查发现右下腹有压痛,有中度局限性反跳痛。妊娠试验结果呈阴性,SARS-CoV-2聚合酶链反应检测结果也呈阴性。白细胞计数为12,500/mm3。静脉给予造影剂后进行的计算机断层扫描(CT)显示阑尾扩张、发炎,无阑尾粪石、脓肿、穿孔和肿瘤。您将如何治疗该病例?





作者信息

David A. Talan, M.D., and Salomone Di Saverio, M.D., Ph.D.
From the Department of Emergency Medicine, UCLA Ronald Reagan Medical Center, and the David Geffen School of Medicine at UCLA — both in Los Angeles (D.A.T.); and the Department of General Surgery, ASUR Marche, AV5, Hospital of San Benedetto del Tronto, San Benedetto del Tronto, Italy (S.D.S.). Address reprint requests to Dr. Talan at the Department of Emergency Medicine, David Geffen School of Medicine at UCLA, 924 Westwood Blvd., Ste. 300, Los Angeles, CA 90095, or at dtalan@ucla.edu.

 

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