保守管理的急性尾炎中的尾瘤:一项回顾性观察性研究
Rahel Rashid1, Baidar Khalabazyane2, Israa Kadhmawi3
1General and Colorectal Surgery, Arrowe Park Hospital, Wirral, GBR.
Cureus
|October 31, 2024
概括
老年人急性尾炎的非手术治疗与更高的意外尾恶性瘤率有关. 目前的后续结肠镜检测不足,这表明需要加强监测策略.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 腹部成像 腹部成像 腹部成像
背景情况:
- 尾瘤在40岁以上患有复杂尾炎的患者中更为常见,特别是那些经过非手术治疗的患者.
- 随着COVID-19大流行,急性尾炎的非手术管理 (NOM) 的使用增加,创造了一个研究意外尾恶性瘤的队列.
- 目前的建议不支持常规间隔尾切除,但建议通过CT和结肠镜进行后续肠道查.
研究的目的:
- 为了比较40岁及以上患者中尾恶性瘤的发病率,在急性尾炎中进行非手术治疗与手术治疗.
- 评估标准的随访肠道查 (CT和结肠镜) 在检测恶性瘤方面的有效性.
- 为了评估急性尾炎的NOM患者的再入院率.
主要方法:
- 一项回顾性观察性研究包括211名40岁以上的患者,在2020年1月至2021年12月期间被诊断患有急性尾炎.
- 患者被分为手术管理 (125例) 和非手术管理 (86例) 队列.
- 有趣的结果包括尾恶性瘤发病率,查疗效和再入院率.
主要成果:
- 在7% (6/86) 的NOM队列中检测到尾恶性瘤,而在手术队列中为1.6% (2/125).
- 常规后续结肠镜检查未能检测出任何恶性瘤;NOM组的所有六例病例都是在间歇性尾切除后发现的.
- 45% (39/86) 的NOM患者至少经历过一次再入院,其中37%发生在第一年内.
结论:
- 40岁及以上的成年人急性尾炎的非手术治疗与意外尾恶性瘤的发病率较高有关.
- 标准的随访结肠镜检查不足以检测这些恶性瘤.
- 对于接受NOM的老年患者,建议进行更密切的监测和潜在的更积极的后续策略,例如例行间隔尾切除术.
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