??889年以来，阑尾切除术一直是治疗阑尾炎的“金标??rdquo;。英国研究人员汇总了以往利用抗生素治疗阑尾炎的相关研究，想验证抗生素代替手术治疗阑尾炎的安全性。结果发现：对于无并发症的阑尾炎，使用抗生素的疗效并不亚于阑尾切除手术??/p>

分析结果表明，用抗生素治疗的900例阑尾炎患者中??3%一年后不需要接受后续治疗。而且，抗生素治疗比手术治疗的并发症少31%??/p>

研究人员还发现：接受抗生素治疗和接受手术治疗的阑尾炎患者相比，住院天数和发生并发症的风险均没有明显差异??/p>

研究负责人、英国诺丁汉大学和皇后医疗中心胃肠外科教授迪利普·洛博博士说：“确诊为无并发症阑尾炎后，即刻开始抗生素治疗，并且对病情进行重新评估，能避免大多数无必要的阑尾切除术。而且抗生素还能缩短患者的住院时间??rdquo;

但洛博博士也承认??ldquo;对无并发症的阑尾炎患者而言，正确诊断比尽早手术更为重要。不过，对已经有明显穿孔或腹膜炎症状的患者，早期阑尾切除术仍然是‘金标??rsquo;??rdquo;

南加州大学凯克医学院外科学副教授罗德??middot;梅森也有类似发现，并在二月份的《手术感染》杂志上发表。他说：“抗生素治疗阑尾炎，并发症的风险比手术小很多??rdquo;

不过患者必须要有这样的思想准备——如果复发，可能还是要手术。梅森说??ldquo;不必承受手术及相关风险的代价就是，患者愿意接受治疗无效和40%左右的复发率。话说回来，还是??0%的人，不用手术就能完全康复??rdquo;

荷兰乌得勒支大学医学中心的奥拉夫·巴克博士为研究撰写了评论，他说：“用抗生素保守治疗，似乎优于手术切除??rdquo;不过他也指出：阑尾切除更少发生并发症，而研究人员已经发现，抗生素治疗在之后一年内??0%的复发率。而在复发的患者中，又??0%发生阑尾穿孔或坏疽性阑尾炎。所以，这个20%的治疗失败率是否可以接受，仍然值得商榷??rdquo;

巴克认为：对这些结果仍然应持谨慎态度，如果没有更多证据支持，阑尾切除术仍然是治疗阑尾炎的首选方案??/p>

迈阿密大学医学院外科学副教授卡尔·舒尔曼博士指出：选择抗生素保守治疗还是手术治疗，涉及到治疗费用问题。虽然抗生素治疗更便宜，但如果治疗失败，患者仍然需要手术的话，总费用反而更高??/p>

此外，医生的建议影响患者的选择??ldquo;如果医生对患者说‘用抗生素，有80%的几率可以不用开刀’，听起来似乎很可行。但医生也可以说‘用过抗生素，有五分之一的患者还是要手术，也许我们应该切掉你的阑尾??rsquo;”

舒尔曼说，对患者来说，得了阑尾炎，最好的做法是咨询医生，做出明智的选择??/p>

#p#副标??e#For people suffering from unplicted ppendicitis, urse of ntibiotics my be just s good s hving the ppendix removed, British reserchers report。

The reserchers reviewed studies involving hundreds of ptients to determine tht tretment with ntibiotics uld be sfe lterntive to surgery, which hs been the so-clled "gold stndrd" of cre for n inflmed ppendix since 1889。

"Strting ntibiotics when the dignis of unplicted cute ppendicitis is mde, with ressessment of the ptient, will prevent the need for mt ppendectomies, rcing ptient morbidity," sid led resercher Dr。 Dileep Lobo, professor of gstrointestinl surgery t the University of Nottinghm nd Queens Medicl Centre。

Antibiotics lso cn shorten ptients hpitl sty, he dded。

Since better digntic tools re now vilble to digne ppendicitis, it is sfe to dopt creful "wit, wtch nd tret" policy for the who hve unplicted ppendicitis or when the dignis is uncertin, Lobo sid。

"In these ptients, rrect dignis rther thn n erly ppendectomy is the key," he sid。 But, he dded, "for ptients with cler signs of perfortion or peritonitis (n inflmmtion of the bdominl wll), erly ppendectomy still remins the gold stndrd。"

For the report, which is published in the April 5 online edition ofBMJ, Lob tem did met-nlysis of four studies in which t totl of 900 ptients with ppendicitis were rndomly ssigned to surgery or ntibiotics。

Among ptients treted with ntibiotics, 63 percent did not need ny further tretment fter yer。 In ddition, ntibiotic use resulted in 31 percent fewer plictions thn surgery, the reserchers found。

Among the more thn 400 ptients treted with ntibiotics, 68 hd recurrent symptoms。 Of the, 13 hd serious ppendicitis, four hd norml ppendix nd three were suessfully treted with more ntibiotics, the reserchers noted。

The reserchers lso found no rel differences in the length of hpitl stys or the risk of plicted ppendicitis between people treted with ntibiotics nd the who underwent surgery。

Dr。 Rodney Mson, n ssocite professor of surgery t the University of Southern Cliforni Keck School of Medicine in L Angeles, reported similr findings in his own study in the Februry issue of the journlSurgicl Infections。 "Antibiotic therpy offers risk of plictions tht is significntly less thn tht of ppendectomy," he sid。

But ptients must be willing to ept the ide tht they my hve to return for surgery if symptoms recur, he sid。

"Ptients must be willing to ept n initil filure nd subsequent recurrence rte of bout 40 percent in exchnge for the psibility of foregoing surgery nd its ssocited risks," Mson sid。 "Hving sid tht, 60 percent of ptients will get by without surgery。"

"Conservtive tretment with ntibiotics seems to do better thn ppendectomy," sid Dr。 Olf Bkker, from the University Medicl Center Utrecht in the Netherlnds nd the uthor of n cpnying journl editoril。

He noted in his editoril, however, tht ppendectomy does not hve lot of plictions, while the reserchers found tht ntibiotic tretment resulted in 20 percent chnce of recurrence within yer。

"Of these recurrences, 20 percent of ptients presented with perforted [ppendix] or gngrenous ppendicitis," he sid。 "It is questionble whether filure rte of 20 percent within one yer is eptble。"

These results therefore should be interpreted with cution, he sid, nd ppendectomy "will probbly remin the tretment for ppendicitis until further studies re done。"

One other expert noted tht the choice is plicted one, nd prt of tht involves the sts of ech tretment。

Although ntibiotics my be cheper, if ptients need to e bck for n ppendectomy fter ntibiotics hve filed, the totl st might end up being higher, sid Dr。 Crl Schulmn, n ssocite professor of surgery t the University of Mimi School of Medicine in Florid。

In ddition, doctors influence ptients decision by wht they sy, he dded。

"You uld sy, With ntibiotics, there is four-in-five chnce tht you wont need n opertion。 Tht seems very resonble," he sid。 "But you uld sy, 20 percent of ptients do e bck fter ntibiotics nd they hve to hve their ppendix out; mybe we should just tke out your ppendix。"

The best ptient cn do is mke n informed choice by sking questions, Schulmn dded。