关键词: 阑尾炎, 指南, 解读, 影像学检查, 手术时机, 抗生素策略

Abstract: The diagnosis and treatment of appendicitis have become relatively standardized, but variations still exist in specific diagnostic and therapeutic details. Proper selection of imaging modalities, choosing an appropriate treatment approach and timing, as well as optimizing perioperative management, are essential for reducing treatment risks and improving patient outcomes. In 2024, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) convened a multidisciplinary Guideline Development Group (GDG) to discuss and develop the “Guidelines for the Diagnosis and Treatment of Appendicitis (2024)” which focuses on critical issues in the diagnosis and management of appendicitis, including diagnostic modalities, treatment strategies, and surgical timing. The guidelines emphasize the importance of imaging in diagnosing acute appendicitis, with CT and MRI demonstrating significantly higher diagnostic accuracy than ultrasound. CT and MRI are recommended as primary diagnostic modalities, with MRI being particularly suitable for women of reproductive age, while ultrasound serves as a reasonable first-line screening tool. For patients with uncomplicated acute appendicitis, surgical intervention is recommended, with appendectomy being the standard treatment. However, for patients who can accept the risk of recurrence, non-surgical management may be considered as an alternative. In cases of complicated appendicitis, studies indicate that surgery is superior to non-surgical treatment, as it can reduce hospital stay and readmission rates, making it suitable for most patients. Additionally, the guidelines provide recommendations on aspects such as delayed surgery, irrigation during aspiration, and drainage placement. For example, the timing of surgery should be based on the patient's clinical situation, and routine drainage placement is not recommended. Regarding postoperative antibiotic use, short-term antibiotic therapy is favored over long-term use in reducing complications. Elective appendectomy is recommended for asymptomatic patients with a history of non-surgical treatment for complicated appendicitis, as it allows for a definitive diagnosis and reduces the risk of missing malignancy, particularly in patients with a family history of cancer. These guidelines provide a reference for the standardized diagnosis and management of appendicitis, guiding clinicians in making optimal diagnostic and therapeutic decisions across varied clinical scenarios to achieve better treatment outcomes and prognosis.

Key words: appendicitis, guidelines, interpretation, imaging modalities, surgical timing, antibiotic strategy