PDF(Sci-hub)
Abstract：
Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy.
This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients.
The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.
This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients.
The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.
摘要：
急性阑尾炎（AA）是急性腹痛的最常见原因之一。AA的诊断仍然具有挑战性，并且在全球不同的环境和实践模式中仍然存在一些关于其管理的争议。2015年7月，世界急诊外科学会（WSES）在耶路撒冷组织了关于成年患者AA诊断和治疗的第一次共识会议，旨在制定循证指南。2019年6月在Nijemegen举行了更新的共识会议，现在已经更新了指南，以提供基于证据的声明和建议，以适应不同的临床实践：在诊断AA中使用临床评分和成像，手术的适应症和时机，使用非手术管理和抗生素，腹腔镜和手术技术，术中评分,和围手术期抗生素治疗。
本执行手稿总结了WSESAA的诊断和治疗指南。文献检索已更新至2019年，并根据GRADE方法制定了声明和建议。声明进行了表决，最终修改，最终得到了共识会议与会者和共同作者委员会的批准，每当在声明或建议上有争议时，使用Delphi方法进行投票。几个表格突出了研究主题和问题，搜索语法,并提供了声明和WSES循证建议。最后,以流程图的形式为成人和儿科(<16岁)患者提供了两种不同的实用临床算法.
关于AA的2020WSES指南旨在就以下每个主题提供最新的基于证据的声明和建议：（1）诊断，(2)不复杂AA的非手术管理，（3）阑尾切除术的时机和住院延误，（4）手术治疗，(5)术中AA分级,(6),治疗穿孔AA伴痰或脓肿，(7)围手术期抗生素治疗。
本执行手稿总结了WSESAA的诊断和治疗指南。文献检索已更新至2019年，并根据GRADE方法制定了声明和建议。声明进行了表决，最终修改，最终得到了共识会议与会者和共同作者委员会的批准，每当在声明或建议上有争议时，使用Delphi方法进行投票。几个表格突出了研究主题和问题，搜索语法,并提供了声明和WSES循证建议。最后,以流程图的形式为成人和儿科(<16岁)患者提供了两种不同的实用临床算法.
关于AA的2020WSES指南旨在就以下每个主题提供最新的基于证据的声明和建议：（1）诊断，(2)不复杂AA的非手术管理，（3）阑尾切除术的时机和住院延误，（4）手术治疗，(5)术中AA分级,(6),治疗穿孔AA伴痰或脓肿，(7)围手术期抗生素治疗。
