探討抗生素治療急性單純性闌尾炎的復發率及其相關影響因子

研究目的：急性闌尾炎臨床治療多以闌尾切除手術進行，抗生素治療急性單純性闌尾炎對患者是一種非侵入性的替代療法。本研究旨在探討抗生素治療單純性闌尾炎的復發率與相關影響因子，藉以區分適合抗生素治療的患者族群。研究方法：本研究資料來源為『全民健康保險資料庫』（LHID2005）的兩百萬承保抽樣歸人檔。以2005年至2012年資料庫篩選出抗生素治療急性闌尾炎患者為分析對象，選取ICD-9-CM codes 540及540.9無併發症的單純性闌尾炎患者，排除540.0、540.1及541等複雜性闌尾炎相關疾病。研究結果：充血性心衰竭患者接受抗生素治療急性闌尾炎的復發風險，是非充血性心衰竭患者的3.06倍（風險比=3.06，95%信賴區間=1.33-7.06，P≤0.01）。結論：本研究結果發現，充血性心衰竭患者接受抗生素治療急性單純性闌尾炎，一年內有較高的闌尾炎復發風險，在統計上有顯著差異。台灣地區抗生素治療急性闌尾炎與慢性病相關研究較為不足，但抗生素治療急性闌尾炎對患者有諸多益處，本研究結果顯示，除去充血性心衰竭的患者外，多數慢性病患者在抗生素治療風險不高。因此，建議外科醫師臨床治療單純性闌尾炎可考慮抗生素治療取代闌尾切除手術，避免經由闌尾切除手術對患者的免疫系統造成破壞，面對癌症潛在的威脅，健康的闌尾是在淋巴與免疫系統中相當重要，應盡力保全闌尾器官以維護患者健康的最大權益。

關鍵字

急性闌尾炎；抗生素治療；非手術治療

並列摘要

INTRODUCTION: There are various treatments for acute appendicitis; however it is normally treated by appendectomy in surgical clinics. An alternative treatment, antibiotic therapy, is used for acute simple appendicitis that has not popularized. The aforementioned therapy is safer and much less invasive. This study focuses on the recurrence and impact factor of acute appendicitis with antibiotic therapy and aims to distinguish which group of patients with acute appendicitis is suitable for antibiotic therapy. METHODS: The data from the “National Health Insurance Research Database” (LHID2005) underwriting sampling file between 2002 to 2012 were included in this study. The database was used to select the acute simple appendicitis patients with ICD-9-CM codes 540 and 540.9; excluding the diseases related to acute complicated appendicitis with ICD-9-CM codes 540.0, 540.1 and 541 respectively. RESULTS: On aggregate, the results indicate that the recurrence risk of antibiotic therapy for acute simple appendicitis on the patients with congestive heart failure is 3.06 higher than patients without congestive heart failure (Hazard Ratios = 3.06, 95% CI = 1.33-7.06, P ≤ 0.01). CONCLUSIONS: The results of this study show that patients with heart failure who accepted antibiotic therapy for acute simple appendicitis have a higher risk of recurrence of acute appendicitis within one year, there is a statistically significant difference. In Taiwan, there are insufficient studies of research about antibiotic therapy of acute appendicitis and chronic diseases. Although antibiotic therapy is quite beneficial to patients with chronic diseases, we should keep the complete appendicitis, an important cycle of the immune system to maintain the whole immune system of human organization. According to the study, most chronic patients are low risk of recurrence of acute appendicitis via antibiotic therapy. As such, during the treatment of acute simple appendicitis for chronic patients, we recommend consideration of the alternative antibiotic therapy instead of appendectomy.

並列關鍵字

Acute appendicitis ； antibiotic therapy ； alternative therapy

參考文獻

Chung, S. D., Chen, Y. K., Kang, J. H., Keller, J. J., Huang, C. C., & Lin, H. C. (2011). Population-based estimates of medical comorbidities in erectile dysfunction in a Taiwanese population. J Sex Med, 8(12), 3316-3324. doi: 10.1111/j.1743-6109.2011.02496.x

一、中文部分