成人の急性炎の診断と治療: レビュー
Dimitrios Moris1, Erik Karl Paulson2, Theodore N Pappas1
1Department of Surgery, Duke University Medical Center, Durham, North Carolina.
JAMA
|December 14, 2021
まとめ
急性盲腸炎は 手術の代わりに 抗生物質で治療できます このアプローチは,合併症のない特定の患者に適しており,尾切除手術の有効な代替案です.
科学分野:
- 胃腸内科
- 手術 の 緊急 状況
- 感染症
背景:
- 急性盲腸炎は,世界中で最も頻繁な外科的緊急事態であり,毎年10万人に96.5〜100人が罹患しています.
- 診断は臨床的表現,検査,画像に依拠し, ~90%の症例で典型的な症状が診断に役立ちます.
研究 の 目的:
- 急性盲腸炎の代替として抗生物質治療の有効性を評価する.
- 非手術治療の成功や失敗を予測する患者のサブグループとイメージング指標を特定する.
主な方法:
- 急性虫炎の臨床診断,古典的な症状,および現在の治療パラダイムのレビュー.
- 合併症のない盲腸炎に対する広範囲の抗生物質 (例えば,ピペラシリンタゾバクタム,セファロスポリン,メトロニダゾールを含むフルオロキノロン) を支持する証拠の分析.
- コンピュータトモグラフィー (CT) の結果と抗生物質治療の結果の相関 (尾直径,尾炎,質量効果)
主要な成果:
- 抗生物質は,約70%の患者で,合併症のない急性尾炎を成功裏に治療できます.
- 盲腸炎,質量効果,または盲腸直径>13mmのCT検出は,抗生物質治療の失敗のリスクが高いことを示します (~40%).
- 手術に適した高リスクCTの患者には尾切除が推奨されます.
結論:
- 臓切除は急性臓炎の主な治療法です
- 抗生物質療法は,特に高リスクCTの発見のない,合併症のない盲腸炎の選択された患者にとって適切な第一線治療です.
- 治療の決定には,手術に対する患者の適性,CTの発見,および患者の好みを考慮する必要があります.
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