复杂性阑尾炎风险评估研究进展
Research Advances in the Risk Assessment of Complicated Appendicitis
摘要: 阑尾炎是常见的急腹症,根据有无并发症可分为非复杂性阑尾炎(Uncomplicated Appendicitis, UA)和复杂性阑尾炎(Complicated Appendicitis, CA)。近年来,非手术管理(Non-operative Management, NOM)在UA中的应用逐渐增多,但手术仍是CA的主要治疗方式。因此,早期准确鉴别UA与CA、进行个体化风险评估,对优化治疗方案和改善患者预后具有重要意义。本文旨在回顾近年来关于复杂性阑尾炎诊断及风险评估的研究进展,以期提升临床医生对该病的认识,并指导临床的诊疗工作。
Abstract: Appendicitis is a common acute abdominal condition, which can be classified into uncomplicated appendicitis (UA) and complicated appendicitis (CA) based on the presence or absence of complications. In recent years, non-operative management (NOM) has been increasingly used in the treatment of UA, but surgery remains the primary approach for CA. Therefore, early and accurate differentiation between UA and CA, along with individualized risk assessment, is of great significance for optimizing treatment strategies and improving patient outcomes. This article aims to review recent research progress in the diagnosis and risk assessment of complicated appendicitis, with the goal of enhancing clinicians’ understanding of the disease and guiding clinical diagnosis and treatment.
文章引用:宋贤浩, 陈道荣. 复杂性阑尾炎风险评估研究进展[J]. 临床医学进展, 2026, 16(4): 409-419. https://doi.org/10.12677/acm.2026.1641263

参考文献

[1] Addiss, D.G., Shaffer, N., Fowler, B.S. and Tauxe, R.V. (1990) The Epidemiology of Appendicitis and Appendectomy in the United States. American Journal of Epidemiology, 132, 910-925. [Google Scholar] [CrossRef] [PubMed]
[2] Moris, D., Paulson, E.K. and Pappas, T.N. (2021) Diagnosis and Management of Acute Appendicitis in Adults: A Review. JAMA, 326, 2299-2311. [Google Scholar] [CrossRef] [PubMed]
[3] Livingston, E.H., Woodward, W.A., Sarosi, G.A. and Haley, R.W. (2007) Disconnect between Incidence of Nonperforated and Perforated Appendicitis. Annals of Surgery, 245, 886-892. [Google Scholar] [CrossRef] [PubMed]
[4] Fugazzola, P., Ceresoli, M., Agnoletti, V., Agresta, F., Amato, B., Carcoforo, P., et al. (2020) The SIFIPAC/WSES/SICG/SIMEU Guidelines for Diagnosis and Treatment of Acute Appendicitis in the Elderly (2019 Edition). World Journal of Emergency Surgery, 15, Article No. 19. [Google Scholar] [CrossRef] [PubMed]
[5] Henriksen, S.R., Christophersen, C., Rosenberg, J. and Fonnes, S. (2023) Varying Negative Appendectomy Rates after Laparoscopic Appendectomy: A Systematic Review and Meta-Analysis. Langenbecks Archives of Surgery, 408, Article No. 205. [Google Scholar] [CrossRef] [PubMed]
[6] Wu, J.X., Dawes, A.J., Sacks, G.D., Brunicardi, F.C. and Keeler, E.B. (2015) Cost Effectiveness of Nonoperative Management versus Laparoscopic Appendectomy for Acute Uncomplicated Appendicitis. Surgery, 158, 712-721. [Google Scholar] [CrossRef] [PubMed]
[7] Carmi, D., Haklai, Z., Gordon, E.S., et al. (2023) Acute Appendicitis Non-Operative Management Rate Trends Over Two Decades (2000 to 2019): The Israel Experience. Israel Medical Association Journal, 25, 101-105.
[8] Afzal, Z., Bukhari, I., Kumar, S., Deeknah, A., Lei, W., Mitrasinovic, S., et al. (2023) Management of Acute Appendicitis during the COVID-19 Pandemic: A Single-Centre Retrospective Cohort Study. Cureus, 15, e37193. [Google Scholar] [CrossRef] [PubMed]
[9] Kumar, S.S., Collings, A.T., Lamm, R., Haskins, I.N., Scholz, S., Nepal, P., et al. (2024) SAGES Guideline for the Diagnosis and Treatment of Appendicitis. Surgical Endoscopy, 38, 2974-2994. [Google Scholar] [CrossRef] [PubMed]
[10] Mentula, P., Sammalkorpi, H. and Leppäniemi, A. (2015) Laparoscopic Surgery or Conservative Treatment for Appendiceal Abscess in Adults? A Randomized Controlled Trial. Annals of Surgery, 262, 237-242. [Google Scholar] [CrossRef] [PubMed]
[11] Dong, Y., Tan, S., Fang, Y., et al. (2018) Meta-Analysis of Laparoscopic Surgery versus Conservative Treatment for Appendiceal Abscess. Chinese Journal of Gastrointestinal Surgery, 21, 1433-1438.
[12] Akingboye, A.A., Mahmood, F., Zaman, S., Wright, J., Mannan, F. and Mohamedahmed, A.Y.Y. (2021) Early versus Delayed (Interval) Appendicectomy for the Management of Appendicular Abscess and Phlegmon: A Systematic Review and Meta-Analysis. Langenbecks Archives of Surgery, 406, 1341-1351. [Google Scholar] [CrossRef] [PubMed]
[13] Suzuki, T., Matsumoto, A., Akao, T. and Matsumoto, H. (2023) Interval Appendectomy as a Safe and Feasible Treatment Approach after Conservative Treatment for Appendicitis with Abscess: A Retrospective, Single-Center Cohort Study. Updates in Surgery, 75, 2257-2265. [Google Scholar] [CrossRef] [PubMed]
[14] Global Burden of Disease Acute Appendicitis Collaborators (2024) Trends and Levels of the Global, Regional, and National Burden of Appendicitis between 1990 and 2021: Findings from the Global Burden of Disease Study 2021. Lancet Gastroenterology & Hepatology, 9, 825-858.
[15] Lotfollahzadeh, S., Lopez, R.A. and Deppen, J.G. (2024) Appendicitis. StatPearls Publishing.
[16] Ranieri, D.M., Enzerra, M.D. and Pickhardt, P.J. (2021) Prevalence of Appendicoliths Detected at CT in Adults with Suspected Appendicitis. American Journal of Roentgenology, 216, 677-682. [Google Scholar] [CrossRef] [PubMed]
[17] Weitzner, Z.N., Chung, A., Naini, B.V., Graham, D. and Livingston, E.H. (2023) Correlation of Computed Tomography, Pathological Findings, and Clinical Outcomes for Appendicoliths in Appendicitis. Annals of Surgery Open, 4, e280. [Google Scholar] [CrossRef] [PubMed]
[18] Lee, M.S., Purcell, R., McCombie, A., Frizelle, F. and Eglinton, T. (2023) Retrospective Cohort Study of the Impact of Faecoliths on the Natural History of Acute Appendicitis. World Journal of Emergency Surgery, 18, Article No. 18. [Google Scholar] [CrossRef] [PubMed]
[19] Kaewlai, R., Wongveerasin, P., Lekanamongkol, W., Wongsaengchan, D., Teerasamit, W., Tongsai, S., et al. (2024) CT of Appendicoliths in Adult Appendicitis: Clinical Significance and Characteristics of Overlooked Cases. European Radiology, 34, 2534-2545. [Google Scholar] [CrossRef] [PubMed]
[20] Vanhatalo, S., Mäkilä, E., Hakanen, A.J., Munukka, E., Salonen, J., Saarinen, T., et al. (2024) Appendicolith Classification: Physical and Chemical Properties of Appendicoliths in Patients with CT Diagnosed Acute Appendicitis—A Prospective Cohort Study. BMJ Open Gastroenterology, 11, e001403. [Google Scholar] [CrossRef] [PubMed]
[21] Narula, N., Gibbs, K.E., Kong, F. and Mukherjee, I. (2023) Appendiceal Intussusception, Diverticula, and Fecalith Associated with Appendicitis. The American Surgeon™, 89, 6257-6259. [Google Scholar] [CrossRef] [PubMed]
[22] Lietzén, E., Grönroos, J.M., Mecklin, J., Leppäniemi, A., Nordström, P., Rautio, T., et al. (2019) Appendiceal Neoplasm Risk Associated with Complicated Acute Appendicitis—A Population Based Study. International Journal of Colorectal Disease, 34, 39-46. [Google Scholar] [CrossRef] [PubMed]
[23] Brunner, M., Lapins, P., Langheinrich, M., Baecker, J., Krautz, C., Kersting, S., et al. (2020) Risk Factors for Appendiceal Neoplasm and Malignancy among Patients with Acute Appendicitis. International Journal of Colorectal Disease, 35, 157-163. [Google Scholar] [CrossRef] [PubMed]
[24] Alajääski, J., Lietzén, E., Grönroos, J.M., Mecklin, J., Leppäniemi, A., Nordström, P., et al. (2022) The Association between Appendicitis Severity and Patient Age with Appendiceal Neoplasm Histology—A Population-Based Study. International Journal of Colorectal Disease, 37, 1173-1180. [Google Scholar] [CrossRef] [PubMed]
[25] Salminen, R., Alajääski, J., Rautio, T., Hurme, S., Nordström, P., Mäkäräinen, E., et al. (2025) Appendiceal Tumor Prevalence in Patients with Periappendicular Abscess. JAMA Surgery, 160, 526-534. [Google Scholar] [CrossRef] [PubMed]
[26] Solis-Pazmino, P., Oka, K., La, K., Termeie, O., Figueroa, L.A., Pilatuna, E., et al. (2023) Incidence Rate and Histology of Appendiceal Neoplasms in Complicated versus Uncomplicated Appendicitis: A Meta-Analysis and Systematic Review. Langenbecks Archives of Surgery, 408, Article No. 432. [Google Scholar] [CrossRef] [PubMed]
[27] Mima, K., Miyanari, N., Itoyama, R., Nakao, Y., Kato, R., Shigaki, H., et al. (2019) Interval Laparoscopic Appendectomy after Antibiotic Therapy for Appendiceal Abscess in Elderly Patients. Asian Journal of Endoscopic Surgery, 13, 311-318. [Google Scholar] [CrossRef] [PubMed]
[28] Skendelas, J.P., Alemany, V.S., Au, V., Rao, D., McNelis, J. and Kim, P.K. (2021) Appendiceal Adenocarcinoma Found by Surgery for Acute Appendicitis Is Associated with Older Age. BMC Surgery, 21, Article No. 228. [Google Scholar] [CrossRef] [PubMed]
[29] Jolly, S., McCullough, T., Gunning, T., Maddern, G. and Wichmann, M. (2023) Incidence of Occult Appendiceal Neoplasm in Patients over 40 Years with Acute Appendicitis: A Single‐Institution Review. Australian Journal of Rural Health, 31, 1261-1265. [Google Scholar] [CrossRef] [PubMed]
[30] Rashid, R., Khalabazyane, B., Kadhmawi, I., Inteti, K., Woodhouse, M. and Hanna, J. (2024) Appendiceal Neoplasm in Conservatively Managed Acute Appendicitis: A Retrospective Observational Study. Cureus, 16, e70480. [Google Scholar] [CrossRef] [PubMed]
[31] Hayes, D., Reiter, S., Hagen, E., Lucas, G., Chu, I., Muñiz, T., et al. (2021) Is Interval Appendectomy Really Needed? A Closer Look at Neoplasm Rates in Adult Patients Undergoing Interval Appendectomy after Complicated Appendicitis. Surgical Endoscopy, 35, 3855-3860. [Google Scholar] [CrossRef] [PubMed]
[32] Fransvea, P., Puccioni, C., Altieri, G., D’Agostino, L., Costa, G., Tropeano, G., et al. (2024) Beyond Acute Appendicitis: A Single-Institution Experience of Unexpected Pathology Findings after 989 Consecutive Emergency Appendectomy. Langenbecks Archives of Surgery, 409, Article No. 87. [Google Scholar] [CrossRef] [PubMed]
[33] Bennion, R.S., Baron, E.J., Thompson, J.E., Downes, J., Summanen, P., Talan, D.A., et al. (1990) The Bacteriology of Gangrenous and Perforated Appendicitis—Revisited. Annals of Surgery, 211, 165-171. [Google Scholar] [CrossRef] [PubMed]
[34] Vitetta, L., Chen, J. and Clarke, S. (2019) The Vermiform Appendix: An Immunological Organ Sustaining a Microbiome Inoculum. Clinical Science, 133, 1-8. [Google Scholar] [CrossRef] [PubMed]
[35] Li, D., Yang, B., Liao, J., Li, Y., Liu, D., Zhao, L., et al. (2023) Endoscopic Retrograde Appendicitis Therapy or Antibiotics for Uncomplicated Appendicitis. British Journal of Surgery, 110, 635-637. [Google Scholar] [CrossRef] [PubMed]
[36] Bhangu, A., Søreide, K., Di Saverio, S., Assarsson, J.H. and Drake, F.T. (2015) Acute Appendicitis: Modern Understanding of Pathogenesis, Diagnosis, and Management. The Lancet, 386, 1278-1287. [Google Scholar] [CrossRef] [PubMed]
[37] Vanhatalo, S., Munukka, E., Kallonen, T., Sippola, S., Grönroos, J., Haijanen, J., et al. (2022) Appendiceal Microbiome in Uncomplicated and Complicated Acute Appendicitis: A Prospective Cohort Study. PLOS ONE, 17, e0276007. [Google Scholar] [CrossRef] [PubMed]
[38] Käser, S.A., Fankhauser, G., Willi, N. and Maurer, C.A. (2010) C-reactive Protein Is Superior to Bilirubin for Anticipation of Perforation in Acute Appendicitis. Scandinavian Journal of Gastroenterology, 45, 885-892. [Google Scholar] [CrossRef] [PubMed]
[39] Qi, F.Q. and Zhang, B. (2015) Clinical Significance of C-Reactive Protein Levels in the Determination of Pathological Type of Acute Appendicitis. International Journal of Clinical and Experimental Medicine, 8, 13887-13890.
[40] Hajibandeh, S., Hajibandeh, S., Hobbs, N. and Mansour, M. (2020) Neutrophil-to-Lymphocyte Ratio Predicts Acute Appendicitis and Distinguishes between Complicated and Uncomplicated Appendicitis: A Systematic Review and Meta-analysis. The American Journal of Surgery, 219, 154-163. [Google Scholar] [CrossRef] [PubMed]
[41] Ünal, Y. (2018) A New and Early Marker in Diagnosis of Acute Complicated Appendicitis: Immature Granulocyte. Turkish Journal of Trauma and Emergency Surgery, 24, 434-439. [Google Scholar] [CrossRef] [PubMed]
[42] Turkes, G.F., Unsal, A. and Bulus, H. (2022) Predictive Value of Immature Granulocyte in the Diagnosis of Acute Complicated Appendicitis. PLOS ONE, 17, e0279316. [Google Scholar] [CrossRef] [PubMed]
[43] Alfehaid, M.S., Babiker, A.M., Alkharraz, A.H., Alsaeed, H.y., Alzunaydi, A.A., Aldubaiyan, A.A., et al. (2023) Elevated Total and Direct Bilirubin Are Associated with Acute Complicated Appendicitis: A Single-Center Based Study in Saudi Arabia. BMC Surgery, 23, Article No. 342. [Google Scholar] [CrossRef] [PubMed]
[44] Gonzalez, D.O., Lawrence, A.E., Cooper, J.N., Sola, R., Garvey, E., Weber, B.C., et al. (2018) Can Ultrasound Reliably Identify Complicated Appendicitis in Children? Journal of Surgical Research, 229, 76-81. [Google Scholar] [CrossRef] [PubMed]
[45] Carpenter, J.L., Orth, R.C., Zhang, W., Lopez, M.E., Mangona, K.L. and Guillerman, R.P. (2017) Diagnostic Performance of US for Differentiating Perforated from Nonperforated Pediatric Appendicitis: A Prospective Cohort Study. Radiology, 282, 835-841. [Google Scholar] [CrossRef] [PubMed]
[46] Di Saverio, S., Podda, M., De Simone, B., et al. (2020) Diagnosis and Treatment of Acute Appendicitis: 2020 Update of the WSES Jerusalem Guidelines. World Journal of Emergency Surgery, 15, Article 27.
[47] Iamwat, J., Teerasamit, W., Apisarnthanarak, P., Noppakunsomboon, N. and Kaewlai, R. (2021) Predictive Ability of CT Findings in the Differentiation of Complicated and Uncomplicated Appendicitis: A Retrospective Investigation of 201 Patients Undergone Appendectomy at Initial Admission. Insights into Imaging, 12, Article No. 143. [Google Scholar] [CrossRef] [PubMed]
[48] Şimşek, O., Şirolu, S., Özkan Irmak, Y., et al. (2024) Comparative Study of Imaging Features in Uncomplicated and Complicated Acute Appendicitis. Turkish Journal of Trauma and Emergency Surgery, 30, 722-728. [Google Scholar] [CrossRef] [PubMed]
[49] Akçiçek, M., Ilgar, M. and Ünlü, S. (2022) Is Acute Appendicitis Complicated or Uncomplicated? Approaching the Question via Computed Tomography. Acta Radiologica, 64, 1755-1764. [Google Scholar] [CrossRef] [PubMed]
[50] Lastunen, K., Leppäniemi, A. and Mentula, P. (2021) Perforation Rate after a Diagnosis of Uncomplicated Appendicitis on Ct. BJS Open, 5, zraa034. [Google Scholar] [CrossRef] [PubMed]
[51] Mervak, B.M., Wilson, S.B., Handly, B.D., Altun, E. and Burke, L.M. (2019) MRI of Acute Appendicitis. Journal of Magnetic Resonance Imaging, 50, 1367-1376. [Google Scholar] [CrossRef] [PubMed]
[52] Yeşiltaş, M., Karakaş, D., Gökçek, B., et al. (2018) Alvarado and Appendicitis Inflammatory Response Scores Can Evaluate Severity of Acute Appendicitis? Turkish Journal of Trauma and Emergency Surgery, 24, 557-562. [Google Scholar] [CrossRef] [PubMed]
[53] Andersson, M., Kolodziej, B. and Andersson, R.E. (2021) Validation of the Appendicitis Inflammatory Response (AIR) Score. World Journal of Surgery, 45, 2081-2091. [Google Scholar] [CrossRef] [PubMed]
[54] Karapolat, B. (2019) Can RIPASA Scoring System Predict the Pathological Stage of Acute Appendicitis? Emergency Medicine International, 2019, Article ID: 8140839. [Google Scholar] [CrossRef] [PubMed]
[55] Atema, J.J., van Rossem, C.C., Leeuwenburgh, M.M., Stoker, J. and Boermeester, M.A. (2015) Scoring System to Distinguish Uncomplicated from Complicated Acute Appendicitis. British Journal of Surgery, 102, 979-990. [Google Scholar] [CrossRef] [PubMed]
[56] Geerdink, T.H., Augustinus, S., Atema, J.J., Jensch, S., Vrouenraets, B.C. and de Castro, S.M.M. (2021) Validation of a Scoring System to Distinguish Uncomplicated from Complicated Appendicitis. Journal of Surgical Research, 258, 231-238. [Google Scholar] [CrossRef] [PubMed]
[57] Lin, H., Tsai, H., Chao, C. and Lin, S. (2021) Periappendiceal Fat-Stranding Models for Discriminating between Complicated and Uncomplicated Acute Appendicitis: A Diagnostic and Validation Study. World Journal of Emergency Surgery, 16, Article No. 52. [Google Scholar] [CrossRef] [PubMed]
[58] Kaewlai, R., Tongsai, S., Teerasamit, W., Wongsaengchan, D., Noppakunsomboon, N., Khamman, P., et al. (2023) Validation of Scoring Systems for the Prediction of Complicated Appendicitis in Adults Using Clinical and Computed Tomographic Findings. Insights into Imaging, 14, Article No. 191. [Google Scholar] [CrossRef] [PubMed]
[59] Scheijmans, J.C.G., Bom, W.J., Ghori, U.H., et al. (2024) Development and Validation of the Scoring System of Appendicitis Severity 2.0. JAMA Surgery, 159, 642-649.
[60] Kobayashi, T., Hidaka, E., Koganezawa, I., Nakagawa, M., Yokozuka, K., Ochiai, S., et al. (2023) Development of a Scoring Model Based on Objective Factors to Predict Gangrenous/Perforated Appendicitis. BMC Gastroenterology, 23, Article No. 198. [Google Scholar] [CrossRef] [PubMed]
[61] Shay, S., Kupietzky, A., Weiss, D.J., Dover, R., Lourie, N.E.E., Mordechay‐Heyn, T., et al. (2021) Composite Criteria for Non‐Operative Management of Acute Non‐Complicated Appendicitis Result in Low Failure Rates. World Journal of Surgery, 46, 69-75. [Google Scholar] [CrossRef] [PubMed]
[62] Kim, H.Y., Park, J.H., Lee, S.S., Jeon, J., Yoon, C.J. and Lee, K.H. (2021) Differentiation between Complicated and Uncomplicated Appendicitis: Diagnostic Model Development and Validation Study. Abdominal Radiology, 46, 948-959. [Google Scholar] [CrossRef] [PubMed]
[63] Xu, T., Zhang, Q., Zhao, H., Meng, Y., Wang, F., Li, Y., et al. (2021) A Risk Score System for Predicting Complicated Appendicitis and Aid Decision-Making for Antibiotic Therapy in Acute Appendicitis. Annals of Palliative Medicine, 10, 6133-6144. [Google Scholar] [CrossRef] [PubMed]
[64] Feng, H., Yu, Q., Wang, J., Yuan, Y., Yu, S., Wei, F., et al. (2022) Development and Validation of a Clinical Prediction Model for Complicated Appendicitis in the Elderly. Frontiers in Surgery, 9, Article ID: 905075. [Google Scholar] [CrossRef] [PubMed]
[65] Wei, W., Tongping, S. and Jiaming, W. (2024) Construction of a Clinical Prediction Model for Complicated Appendicitis Based on Machine Learning Techniques. Scientific Reports, 14, Article No. 16473. [Google Scholar] [CrossRef] [PubMed]
[66] Cai, J., Zhou, H., Liang, D., Chen, Q., Xiao, Y. and Li, G. (2023) Parsimonious Clinical Prediction Model for the Diagnosis of Complicated Appendicitis. Heliyon, 9, e19067. [Google Scholar] [CrossRef] [PubMed]
[67] Ma, T., Zhang, Q., Zhao, H. and Zhang, P. (2025) Diagnostic Value of the MZXBTCH Scoring System for Acute Complex Appendicitis. Scientific Reports, 15, Article No. 1366. [Google Scholar] [CrossRef] [PubMed]
[68] Chen, S., Xia, J., Xu, B., Huang, Y., Teng, M. and Pan, J. (2025) Risk Prediction and Effect Evaluation of Complicated Appendicitis Based on XGBoost Modeling. BMC Gastroenterology, 25, Article No. 295. [Google Scholar] [CrossRef] [PubMed]