??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 uncomplicated appendicitis, a course of antibiotics may be just as good as having the appendix removed, British researchers report.

The researchers reviewed studies involving hundreds of patients to determine that treatment with antibiotics could be a safe alternative to surgery, which has been the so-called "gold standard" of care for an inflamed appendix since 1889.

"Starting antibiotics when the diagnosis of uncomplicated acute appendicitis is made, with reassessment of the patient, will prevent the need for most appendectomies, reducing patient morbidity," said lead researcher Dr. Dileep Lobo, professor of gastrointestinal surgery at the University of Nottingham and Queens Medical Centre.

Antibiotics also can shorten a patients hospital stay, he added.

Since better diagnostic tools are now available to diagnose appendicitis, it is safe to adopt a careful "wait, watch and treat" policy for those who have uncomplicated appendicitis or when the diagnosis is uncertain, Lobo said.

"In these patients, correct diagnosis rather than an early appendectomy is the key," he said. But, he added, "for patients with clear signs of perforation or peritonitis (an inflammation of the abdominal wall), early appendectomy still remains the gold standard."

For the report, which is published in the April 5 online edition ofBMJ, Lobos team did a meta-analysis of four studies in which at total of 900 patients with appendicitis were randomly assigned to surgery or antibiotics.

Among patients treated with antibiotics, 63 percent did not need any further treatment after a year. In addition, antibiotic use resulted in 31 percent fewer complications than surgery, the researchers found.

Among the more than 400 patients treated with antibiotics, 68 had recurrent symptoms. Of those, 13 had serious appendicitis, four had a normal appendix and three were successfully treated with more antibiotics, the researchers noted.

The researchers also found no real differences in the length of hospital stays or the risk of complicated appendicitis between people treated with antibiotics and those who underwent surgery.

Dr. Rodney Mason, an associate professor of surgery at the University of Southern California Keck School of Medicine in Los Angeles, reported similar findings in his own study in the February issue of the journalSurgical Infections. "Antibiotic therapy offers a risk of complications that is significantly less than that of appendectomy," he said.

But patients must be willing to accept the idea that they may have to return for surgery if symptoms recur, he said.

"Patients must be willing to accept an initial failure and subsequent recurrence rate of about 40 percent in exchange for the possibility of foregoing surgery and its associated risks," Mason said. "Having said that, 60 percent of patients will get by without surgery."

"Conservative treatment with antibiotics seems to do better than appendectomy," said Dr. Olaf Bakker, from the University Medical Center Utrecht in the Netherlands and the author of an accompanying journal editorial.

He noted in his editorial, however, that appendectomy does not have a lot of complications, while the researchers found that antibiotic treatment resulted in a 20 percent chance of recurrence within a year.

"Of these recurrences, 20 percent of patients presented with a perforated [appendix] or gangrenous appendicitis," he said. "It is questionable whether a failure rate of 20 percent within one year is acceptable."

These results therefore should be interpreted with caution, he said, and appendectomy "will probably remain the treatment for appendicitis until further studies are done."

One other expert noted that the choice is a complicated one, and part of that involves the costs of each treatment.

Although antibiotics may be cheaper, if patients need to come back for an appendectomy after antibiotics have failed, the total cost might end up being higher, said Dr. Carl Schulman, an associate professor of surgery at the University of Miami School of Medicine in Florida.

In addition, doctors influence a patients decision by what they say, he added.

"You could say, With antibiotics, there is a four-in-five chance that you wont need an operation. That seems very reasonable," he said. "But you could say, 20 percent of patients do come back after antibiotics and they have to have their appendix out; maybe we should just take out your appendix."

The best a patient can do is make an informed choice by asking questions, Schulman added.