回首頁    .加為最愛    .連絡我們    .景升主網站
 
寄給朋友| 友善列印| 字級設定: 小 中 大 巨

小兒盲腸炎 一定要開刀嗎?

小兒盲腸炎一定要開刀嗎?其實不一定
小兒盲腸炎一定要開刀嗎?其實不一定

昨天家人緊急通知我,我妹妹的小女兒生病住院。

住院的原因是從前一天開始上吐下瀉,肚子疼痛。隔天凌晨送到醫院急診室,做了電腦斷層和其他檢查,醫生懷疑是急性盲腸炎,建議開刀治療。

家人很擔心,打電話問我怎麼辦?

我有點懷疑盲腸炎的診斷,照說急性盲腸炎應該會發燒才對,而且如果是細菌性盲腸炎,甚至還會有發冷現象。所以我告訴家人,暫時不要開刀,先觀察看看。

昨晚我妹妹打電話告訴我說,醫生認為有九成的機會是盲腸炎,還是建議開刀。

我問了小朋友現在的狀況怎樣,回答是偶爾腹痛,開始有發燒現象了。白血球和發炎指數都相當高,可能有輕微的腹膜炎了。

這下我可兩難了,開刀?小朋友的肚子將永遠留下疤痕,不開刀,盲腸炎會好嗎?

經過和主治醫師討論,以及我查證醫學文獻的結果,結論是:小兒盲腸炎不一定要開刀。

我查證的醫學文獻在下面,有興趣的網友可以用翻譯軟體看看。

 

J Pediatr Surg. 2010 Nov;45(11):2181-5.
Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review.
Lee SL, Islam S, Cassidy LD, Abdullah F, Arca MJ; 2010 American Pediatric Surgical Association Outcomes and Clinical Trials Committee.
Division of Pediatric Surgery, David Geffen School of Medicine at UCLA and Harbor-UCLA Medical Center, Box 709818, Los Angeles, CA 90095, USA. slleemd@yahoo.com
Abstract
OBJECTIVE: The aim of the study was to review evidence-based data regarding the use of antibiotics for the treatment of appendicitis in children.
DATA SOURCE: Data were obtained from PubMed, MEDLINE, and citation review.
STUDY SELECTION: We conducted a literature search using "appendicitis" combined with "antibiotics" with children as the target patient population. Studies were selected based on relevance for the following questions: (1) What perioperative antibiotics should be used for pediatric patients with nonperforated appendicitis? (2) For patients with perforated appendicitis treated with appendectomy: a. What perioperative intravenous antibiotics should be used? b. How long should perioperative intravenous antibiotics be used? c. Should oral antibiotics be used? (3) For patients with perforated appendicitis treated with initial nonoperative management, what antibiotics should be used in the initial management?
RESULTS: Children with nonperforated appendicitis should receive preoperative, broad-spectrum antibiotics. In children with perforated appendicitis who had undergone appendectomy, intravenous antibiotic duration should be based on clinical criteria. Furthermore, broad-spectrum, single, or double agent therapy is as equally efficacious as but is more cost-effective than triple agent therapy. If intravenous antibiotics are administered for less than 5 days, oral antibiotics should be administered for a total antibiotic course of 7 days. For children with perforated appendicitis who did not initially undergo an appendectomy, the duration of broad-spectrum, intravenous antibiotics should be based on clinical symptoms.
CONCLUSIONS: Current evidence supports the use of guidelines as described above for antibiotic therapy in children with acute and perforated appendicitis.

Surg Infect (Larchmt). 2008 Aug;9(4):481-8.
Surgery for appendicitis: is it necessary?
Mason RJ.
Division of Emergency Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California and Los Angeles County and USC Medical Center, Los Angeles, California, USA. rmason@surgery.usc.edu
Abstract
BACKGROUND: Appendectomy for acute appendicitis is an effective, universally accepted procedure performed more than 300,000 times annually in the United States. It is generally believed that appendicitis progresses invariably from early inflammation to later gangrene and perforation, and that appendectomy is required for surgical source control. Although non-operative management with antibiotics of uncomplicated diverticulitis, salpingitis, and neonatal enterocolitis is now established, the non-operative management of appendicitis remains largely unexplored.
METHODS: Systematic review of published literature and derived expert opinion.
RESULTS: Clinical, epidemiologic, radiologic, and pathologic evidence is presented for spontaneous resolution of uncomplicated acute appendicitis. The pathogenesis of appendicitis is reviewed with specific consideration of the role of bacterial infection in the pathogenesis. Evidence is also provided documenting the clinical success of non-operative management.
CONCLUSIONS: Appendectomy may not be necessary for the majority of patients with acute uncomplicated appendicitis, as many patients resolve spontaneously and others may be treatable with antibiotics alone. However, the supporting documentation is scant and of poor quality. A randomized, prospective trial of non-operative management versus early appendectomy of acute uncomplicated appendicitis corroborated by radiologic imaging is called for.


World J Surg. 2006 Jun;30(6):1033-7.
Appendectomy versus antibiotic treatment in acute appendicitis. a prospective multicenter randomized controlled trial.
Styrud J, Eriksson S, Nilsson I, Ahlberg G, Haapaniemi S, Neovius G, Rex L, Badume I, Granström L.
Department of Surgery, Karolinska Institutet at Danderyd Hospital, S-182 88, Stockholm, Sweden. johan.styrud@ds.se
Comment in:
• World J Surg. 2007 Mar;31(3):615; author reply 616.
• World J Surg. 2007 Apr;31(4):871-2.
Abstract
BACKGROUND: Appendectomy has been the treatment for acute appendicitis for over 120 years. Antibiotic treatment has occasionally been used in small uncontrolled studies, instead of operation, but this alternative has never before been tried in a multicenter randomized trial.
PATIENTS AND METHODS: Male patients, 18-50 years of age, admitted to six different hospitals in Sweden between 1996 and 1999 were enrolled in the study. No women were enrolled by decision of the local ethics committee. If appendectomy was planned, patients were asked to participate, and those who agreed were randomized either to surgery or to antibiotic therapy. Patients randomized to surgery were operated on with open surgery or laparoscopically. Those randomized to antibiotic therapy were treated intravenously for 2 days, followed by oral treatment for 10 days. If symptoms did not resolve within 24 hours, an appendectomy was performed. Participants were monitored at the end of 1 week, 6 weeks, and 1 year.
RESULTS: During the study period 252 men participated, 124 in the surgery group and 128 in the antibiotic group. The frequency of appendicitis was 97% in the surgery group and 5% had a perforated appendix. The complication rate was 14% in the surgery group. In the antibiotic group 86% improved without surgery; 18 patients were operated on within 24 hours, and the diagnosis of acute appendicitis was confirmed in all but one patient, and he was suffering from terminal ileitis. There were seven patients (5%) with a perforated appendix in this group. The rate of recurrence of symptoms of appendicitis among the 111 patients treated with antibiotics was 14% during the 1-year follow-up.
CONCLUSIONS: Acute non-perforated appendicitis can be treated successfully with antibiotics. However, there is a risk of recurrence in cases of acute appendicitis, and this risk should be compared with the risk of complications after appendectomy.


J Chir (Paris). 2009 Oct;146 Spec No 1:17-21. Epub 2009 Oct 28.
[Can acute appendicitis be treated by antibiotics and in what conditions?].
[Article in French]
Vons C.
Service de chirurgie digestive, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy cedex, France. corinne.vons@jvr.aphp.fr
Abstract
The current treatment for acute appendicitis is an appendectomy. Several studies have, however, assessed the efficacy of an antibiotic for treating acute appendicitis that is either uncomplicated or complicated by local peritonitis. A meta-analysis in 2007 that collected the results of 44 prospective studies showed that antibiotics were efficacious in 92.8% of cases of appendicitis complicated by local peritonitis, with percutaneous drainage of an abscess when necessary. No predictive factor for failure was identified. The failure of antibiotic treatment did not increase morbidity. Over time and on the whole, the recurrence rate was only 8.9%. The risk of cancer of the appendix (1.5%) nonetheless led to the recommendation of an interval appendectomy for adults. Four randomized controlled trials have compared antibiotic treatment with an appendectomy for the treatment of uncomplicated acute appendicitis. The efficacy of the antibiotic treatment ranged from 86 to 100% and the recurrence rate from 10.4 to 35%. These studies have had various methodological impediments; however, too few patients were included (40 and 80 patients), or only a clinical diagnosis was made before inclusion, or important protocol violations occurred, in particular for almost half the patient in the antibiotic therapy group in the 2009 study. These problems prevent us from relying on these authors' findings. Antibiotics have a role in the initial treatment of acute appendicitis complicated by local peritonitis. In uncomplicated acute appendicitis, the methodological inadequacy of the currently available randomized trials makes it impossible to reach a definitive conclusion about the efficacy of antibiotics.

 

推到Plurk噗浪! 推到Twitter推特! 推到Facebook臉書!
文章分類: 生活醫學隨筆
人氣: 3277
推薦: 9
上一篇:絲襪美腿的真相    (2011/1/18 23:36)
下一篇:晶雕飛梭雷射〈SmartXide〉 治療簡介    (2011/3/6 23:35)
  相關文章
   冷刺激促進新陳代謝的醫學證據    (2013/10/11 上午 06:47:47)
   改變不合時宜和沒有科學根據的養生觀    (2013/9/17 下午 05:22:27)
   吃冰和喝冰水到底有甚麼錯?    (2013/9/9 上午 11:41:14)
   臺北無可取代 文/任孝琦     (2013/7/3 上午 12:33:51)
   阿魏酸--皮膚緊實拉提的好幫手    (2013/1/23 下午 03:29:40)
   壓力和肥胖的關聯    (2012/4/23 下午 11:22:15)
  留言和回應
  共:1 篇回應
我的孩子在在長庚準備開刀.盲腸炎但不痛怎麼辦?
和主治醫師討論,開刀的好處和壞處,以及不開刀痊癒的機率和風險,再做決定吧...
 sandra 於2011/8/28 23:55 (IP:125.228.235.xxx)
上一頁|  1  |下一頁   頁數:1/1
  我要留言
您的暱稱:
您的信箱:
內容:
留言內容限250字以內( 回應間隔時間需為30秒以上,請勿灌水 )
   
驗證: 
  ( 請輸入上圖四位數字驗證碼 )
   
  ( 您發言使用的電腦IP:54.82.166.45 )
注意事項: 網友發言請遵守規範,禁止發表、複製和傳播下列文字:
  1. 人身攻擊、詆譭謾罵、粗鄙不雅、探人隱私、口水爭執
2. 宣揚迷信、色情、賭博、暴力、教唆犯罪
3. 違反著作權法的文章、影音、連結等。
上述貼文一經發現,管理者可不通知作者、不作公告而逕行刪除。

這樣整才型
瘦小腿
雷射溶脂
隆乳,自體脂肪隆乳

隆乳 no.1 自體脂肪隆乳總是胖在不該胖的地方?自體脂肪隆乳讓你圓夢...
瘦腿 no_2 瘦腿不論你怎麼指壓,推拿、運動,想瘦的地方就是瘦不了...
名模纖腿術瘦小腿 no.3「名模纖腿術」瘦小腿縮小粗大的腿肌,不會有代償性肥大的問題...
瘦小腹 no.4 瘦小腹運動推拿是無法瘦小腹的,溶脂改善脂肪堆積問題...
瘦臉 no.5 瘦臉效果明顯,經驗豐富的醫師,風險降低,成功率提高...
男性女乳 no.6 男性女乳乳頭下方的乳險組織需要特殊處理才能有明顯效果...
抽脂 no.7 減肥 瘦身 抽脂美國減肥學會第一位華人醫師輕鬆打造魔鬼身材!
4D埋線拉皮/羽毛線拉皮 no.84D埋線拉皮 最新的4D埋線拉皮改良絲線拉皮的缺點...
瘦手臂 no_9 瘦手臂 手臂會洩漏年齡!臉部再怎麼保樣看起來還是老...
狐臭光纖雷射治療 no_10 狐臭雷射光纖治療 光纖雷射狐臭治療,讓您輕鬆告別異味的困擾...

固定連結

瘦小腿

就是愛瘦美

雷射溶脂知識網

減肥知識網

自體脂肪隆乳
名模纖腿瘦小腿
減肥瘦身
雷射溶脂引流抽脂
PChome新聞台Blog
邱正宏百度空間
新浪博客
必瘦必美網
景升醫美中心部落格