小儿急性阑尾炎的治疗进展：保守治疗与积极手术的选择

Advances in Pediatric Acute Appendicitis: Conservative Management vs. Surgical Intervention

摘要: 小儿急性阑尾炎作为儿科最常见的急腹症之一，其治疗策略的优化直接关系到患儿的预后与生活质量。近年来，随着影像学诊断技术的进步和强效抗生素的广泛应用，传统以手术切除为主的治疗模式正面临挑战。保守治疗(以抗生素为核心)在非复杂性阑尾炎中展现出良好的疗效，可避免手术创伤及麻醉风险；而积极手术(尤其是腹腔镜技术)在复杂性阑尾炎中仍占据主导地位，且围手术期管理的精细化显著降低了并发症发生率。同时，基于患儿年龄、影像分型与粪石等风险因素的个体化治疗决策，是优化临床路径与改善预后的核心方向；本文整合高质量临床试验证据，为上述个体化治疗选择提供循证依据。

Abstract: Acute appendicitis is the most common surgical emergency in children, and the optimization of treatment strategies directly impacts patient prognosis and quality of life. In recent years, advances in imaging diagnostic techniques and the widespread use of highly effective antibiotics have challenged the traditional surgery-dominated treatment model. Conservative treatment (with antibiotics as the core) demonstrates favorable efficacy in uncomplicated appendicitis, avoiding surgical trauma and anesthesia-related risks; whereas active surgery—particularly laparoscopic techniques—remains predominant for complicated appendicitis, with refined perioperative management markedly reducing complication rates. Meanwhile, individualized treatment decisions based on risk factors such as patient age, imaging classification, and fecaliths represent the core direction for optimizing clinical pathways and improving outcomes. This review integrates evidence from landmark clinical trials to guide such individualized treatment selection.