演題

腫瘤形成性虫垂炎に対する非外科的治療の不成功予測因子

[演者] 貞苅 良彦:1,2
[著者] 伊達 聡美:1,2, 永吉 絹子:1, 藤田 逸人:1, 永井 俊太郎:1, 真鍋 達也:1, 大塚 隆生:1, 永井 英司:1, 中村 雅史:1
1:九州大学病院 第1外科, 2:JCHO 九州病院 外科

Background
Non-surgical treatment is an approach for complicated appendicitis. However, non-surgical treatment is occasionally converted to surgery to control infection. The predictive factors for unsuccessful outcomes are still unclear.
Methods
Of 594 patients with acute appendicitis, 34 (5.7%) who were diagnosed with complicated appendicitis were initially treated conservatively. They were divided into two groups. The conservative group was treated with antibiotics in which some of the patients had interval appendectomy. The conversion group comprised patients who had surgical conversion, despite non-surgical treatment. Risk factors for the conversion group were investigated by comparing clinical and radiological parameters between the groups.
Results
Eight patients were converted to surgical management in 5.5 preoperative days. There were no differences in pretreatment clinical parameters between the groups. However, the conversion group had a significantly higher body temperature (BT), and a lower rate of improvement in the white blood cell (WBC) count and BT on the 1st day of antibiotic treatment compared with the conservative group. The conversion group had a long operative time, and high morbidity and conversion rates (laparoscopy to open surgery).
Conclusions
Contributing factors in predicting unsuccessful outcomes for non-surgical treatment include BT, and the rate of improvement in WBC count and BT.
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