靳艳文，叶 辉，李富宇，熊先泽，程南生

(四川大学华西医院胆道外科，成都 610041)

·循证医学·

抗菌药物与手术治疗单纯性急性阑尾炎的系统评价

靳艳文，叶 辉，李富宇，熊先泽，程南生△

(四川大学华西医院胆道外科，成都 610041)

[摘要] 目的 评价抗菌药物保守治疗与阑尾切除术治疗单纯性急性阑尾炎(AA)的疗效与安全性。方法 计算机检索中国生物医学文献数据库(CBM，1978年至2015年6月)、中国期刊全文数据库(CNKI，1979年至2015年6月)、Medline(1950年至2015年6月)、Pubmed(1950年至2015年6月)、Embase(1970年至2015年6月)和Cochrane图书馆(2015年第2期)，收集抗菌药物保守治疗与阑尾切除术治疗单纯性AA的随机对照试验(RCT)，按照Cochrane系统评价方法，由两名研究者独立地对符合纳入标准的试验进行资料提取，并对纳入文献进行质量评估和对提取的有效数据进行Meta分析。结果 纳入6个RCTs，共1 510例单纯性AA患者符合纳入标准，其中使用抗菌药物治疗的有767例，采用阑尾切除术治疗的有743例。与手术治疗比较，抗菌药物保守治疗的有效率降低了25.00%(RD=-0.25，95%CI：-0.35～-0.14)，复发率升高48.43倍(OR=48.43，95%CI：16.94～138.44)，劳动力丧失时间缩短1.52 d (MD=-1.52，95%CI：-3.02～-0.02)，但在并发症的发生率(RD=-0.06,95%CI：-0.15～0.03)、疼痛时间(MD=-0.76，95%CI：-3.31～1.79)、住院时间(MD=4.60，95%CI：-0.89～10.09)、病假时间(MD=-2.39，95%CI：-5.62～0.84)方面两种治疗方法比较，差异无统计学意义(P>0.05)。结论 阑尾切除术可能仍是治疗单纯性AA的金标准方法。

抗菌药；阑尾切除术；阑尾炎；随机对照试验；Meta分析

[Abstract] Objective To evaluate the efficacy and safety of antibacterial drugs conservative therapy versus appendectomy for treating simple acute appendicitis(AA).Methods Randomized controlled trials (RCT) on antibacterial drugs conservative therapy versus appendectomy for treating simple AA were retrieved from CBM (1978- June 2015),CNKI (1979- June 2015),Medline (1950-June 2015),Pubmed (1950-June 2015),Embase (1970-June 2015) and Cochrane library (issue 2,2015) by computer.The included RCTs were performed the data extraction according to the criteria of the Cochrane handbook by two researchers.Then the included d/literatures were performed the quality assessment and the extracted effective data were performed the meta analysis.Results Six RCTs were included involving 1510 patients with AA,among them,767 cases were treated with antibacterial drugs and 743 cases were treated with appendectomy.Compared with surgical treatment,the effect rate of antibacterial medication conservative therapy was decreased by 25.00% (RD=-0.25，95%CI:-0.35--0.14),the recurrence rate was increased by 48.43 times (OR=48.43，95%CI:16.94-138.44),the loss time of labor force was shortened by 1.52 d (MD=-1.52，95%CI:-3.02--0.02),but the occurrence rate of complications(RD=-0.06,95%CI:-0.15-0.03),pain time(MD=-0.76，95%CI:-3.31-1.79),hospital stay time (MD=4.60，95%CI:-0.89-10.09) and sick leave time(MD=-2.39，95%CI:-5.62-0.84) had no statistical differences between the two kinds of treatment method(P>0.05).Conclusion Appendectomy may be the gold standard method for treating simple AA.

急性阑尾炎(acute appendicitis，AA)是外科最常见的腹部急症之一，从19世纪80年代开始，阑尾切除术被认为是单纯性AA的金标准治疗方法[1-2]，而在以前有学者提出使用抗菌药物保守治疗单纯性AA[3-4]，近年来有许多研究证实保守治疗AA……