研究目的：急性闌尾炎臨床治療多以闌尾切除手術進行，抗生素治療急性單純性闌尾炎對患者是一種非侵入性的替代療法。本研究旨在探討抗生素治療單純性闌尾炎的復發率與相關影響因子，藉以區分適合抗生素治療的患者族群。

研究方法：本研究資料來源為『全民健康保險資料庫』（LHID2005）的兩百萬承保抽樣歸人檔。以2005年至2012年資料庫篩選出抗生素治療急性闌尾炎患者為分析對象，選取ICD-9-CM codes 540及540.9無併發症的單純性闌尾炎患者，排除540.0、540.1及541等複雜性闌尾炎相關疾病。

研究結果：充血性心衰竭患者接受抗生素治療急性闌尾炎的復發風險，是非充血性心衰竭患者的3.06倍（風險比=3.06，95%信賴區間=1.33-7.06，P≤0.01）。

結論：本研究結果發現，充血性心衰竭患者接受抗生素治療急性單純性闌尾炎，一年內有較高的闌尾炎復發風險，在統計上有顯著差異。台灣地區抗生素治療急性闌尾炎與慢性病相關研究較為不足，但抗生素治療急性闌尾炎對患者有諸多益處，本研究結果顯示，除去充血性心衰竭的患者外，多數慢性病患者在抗生素治療風險不高。因此，建議外科醫師臨床治療單純性闌尾炎可考慮抗生素治療取代闌尾切除手術，避免經由闌尾切除手術對患者的免疫系統造成破壞，面對癌症潛在的威脅，健康的闌尾是在淋巴與免疫系統中相當重要，應盡力保全闌尾器官以維護患者健康的最大權益。

INTRODUCTION: There are various treatments for acute appendicitis; however it is normally treated by appendectomy in surgical clinics. An alternative treatment, antibiotic therapy, is used for acute simple appendicitis that has not popularized. The aforementioned therapy is safer and much less invasive. This study focuses on the recurrence and impact factor of acute appendicitis with antibiotic therapy and aims to distinguish which group of patients with acute appendicitis is suitable for antibiotic therapy.

METHODS: The data from the “National Health Insurance Research Database” (LHID2005) underwriting sampling file between 2002 to 2012 were included in this study. The database was used to select the acute simple appendicitis patients with ICD-9-CM codes 540 and 540.9; excluding the diseases related to acute complicated appendicitis with ICD-9-CM codes 540.0, 540.1 and 541 respectively.

RESULTS: On aggregate, the results indicate that the recurrence risk of antibiotic therapy for acute simple appendicitis on the patients with congestive heart failure is 3.06 higher than patients without congestive heart failure (Hazard Ratios = 3.06, 95% CI = 1.33-7.06, P ≤ 0.01).

CONCLUSIONS: The results of this study show that patients with heart failure who accepted antibiotic therapy for acute simple appendicitis have a higher risk of recurrence of acute appendicitis within one year, there is a statistically significant difference. In Taiwan, there are insufficient studies of research about antibiotic therapy of acute appendicitis and chronic diseases. Although antibiotic therapy is quite beneficial to patients with chronic diseases, we should keep the complete appendicitis, an important cycle of the immune system to maintain the whole immune system of human organization. According to the study, most chronic patients are low risk of recurrence of acute appendicitis via antibiotic therapy. As such, during the treatment of acute simple appendicitis for chronic patients, we recommend consideration of the alternative antibiotic therapy instead of appendectomy.

第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 5
第三節 研究目的 9
第四節 研究重要性 10
第二章 文獻探討 11
第一節 急性闌尾炎疾病介紹 11
第二節 闌尾切除手術發展 15
第三節 闌尾炎抗生素治療發展 17
第三章 研究方法 19
第一節 研究設計 19
第二節 研究架構 20
第三節 研究假說 22
第四節 研究對象 23
第五節 資料來源 25
第六節 研究變項與操作型定義 26
第七節 資料處理與統計方法 30
第四章 研究結果 31
第一節 描述性統計分析 32
第二節 人口學變項與一年內復發急性闌尾炎進行闌尾炎切除手術相關性分析 34
第三節 32種合併症與一年內復發急性闌尾炎進行闌尾炎切除手術相關性分析 40
第五章 討論 45
第一節 抗生素治療急性闌尾炎之復發率 45
第二節 急性單純性闌尾炎抗生素治療再手術危險因子探討 47
第三節 研究限制 49
第六章 結論 50
第一節 結論 50
第二節 建議 51
參考文獻 52
一、中文部分 52
二、英文部分 53

一、中文部分
李丞騏、何蕙余、武孟餘、周邦昀、鄭志軒、劉育澤、廖健宏(2015)。華盛頓外科學手冊第六版，頁273-290。
李思鈺 (2006)。預防性抗生素臨床指引與治療結果之關係-以闌尾切除術為例。未出版碩士論文。臺灣大學衛生政策與管理研究所。
張郼榮(2013)。兒童穿孔性闌尾炎的臨床分析。未出版碩士論文。國立中興大學生命科學院研究所。
連婉菁(2011)。成人急性闌尾炎經非手術治療之臨床特質及預後分析。未出版博士論文。臺灣大學流行病學與預防醫學研究所。
陳建成(2015)。闌尾炎手術的時機：延遲手術是否會增加併發症。未出版碩士論文。國立陽明大學陽明急重症醫學研究所。
盧偉(2009)。比較傳統式及腹腔鏡式闌尾切除之住院盛行率、醫療資源耗用及其影響因素之研究。未出版碩士論文。國立中山大學醫務管理研究所。
賴鴻緒、陳石池、陳炯年 (2013)。外科急性腹痛第二版。國立台灣大學醫學院科學叢書，頁129-141。

 
二、英文部分
Addiss, D. G., Shaffer, N., Fowler, B. S., & Tauxe, R. V. (1990). The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol, 132(5), 910-925.
Agresta, F., Ansaloni, L., Catena, F., Verza, L. A., & Prando, D. (2014). Acute appendicitis: position paper, WSES, 2013. World Journal of Emergency Surgery, 9(1), 1-4. doi: 10.1186/1749-7922-9-26
Andersen, B. R., Kallehave, F. L., & Andersen, H. K. (2005). Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database Syst Rev(3), Cd001439. doi: 10.1002/14651858.CD001439.pub2
Blomqvist, P. G., Andersson, R. E., Granath, F., Lambe, M. P., & Ekbom, A. R. (2001). Mortality after appendectomy in Sweden, 1987-1996. Ann Surg, 233(4), 455-460.
Chung, S. D., Chen, Y. K., Kang, J. H., Keller, J. J., Huang, C. C., & Lin, H. C. (2011). Population-based estimates of medical comorbidities in erectile dysfunction in a Taiwanese population. J Sex Med, 8(12), 3316-3324. doi: 10.1111/j.1743-6109.2011.02496.x
Coldrey, E. (1956). Treatment of Acute Appendicitis. Br Med J, 2(5007), 1458-1461.
Di Sebastiano, P., Fink, T., di Mola, F. F., Weihe, E., Innocenti, P., Friess, H., & Büchler, M. W. (1999). Neuroimmune appendicitis. The Lancet, 354(9177), 461-466. doi: http://dx.doi.org/10.1016/S0140-6736(98)10463-4
Ehlers, A. P., Talan, D. A., Moran, G. J., Flum, D. R., & Davidson, G. H. (2016). Evidence for an Antibiotics-First Strategy for Uncomplicated Appendicitis in Adults: A Systematic Review and Gap Analysis. J Am Coll Surg, 222(3), 309-314. doi: 10.1016/j.jamcollsurg.2015.11.009
Elixhauser, A., Steiner, C., Harris, D. R., & Coffey, R. M. (1998). Comorbidity measures for use with administrative data. Med Care, 36(1), 8-27.
Faiz, O., Clark, J., Brown, T., Bottle, A., Antoniou, A., Farrands, P., . . . Aylin, P. (2008). Traditional and laparoscopic appendectomy in adults: outcomes in English NHS hospitals between 1996 and 2006. Ann Surg, 248(5), 800-806. doi: 10.1097/SLA.0b013e31818b770c
Fitz , R. (1886). Perforating Inflammation of the Vermiform Appendix with Special Reference to Its Early Diagnosis and Treatment. American Journal of the Medical Sciences, 92, 321-346.
Grover, C. A., & Sternbach, G. (2012). Charles McBurney: McBurney''s point. J Emerg Med, 42(5), 578-581. doi: 10.1016/j.jemermed.2011.06.039
Hansson, J., Körner, U., Khorram-Manesh, A., Solberg, A., & Lundholm, K. (2009). Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. British Journal of Surgery, 96(5), 473-481. doi: 10.1002/bjs.6482
Hansson, J., Korner, U., Ludwigs, K., Johnsson, E., Jonsson, C., & Lundholm, K. (2012). Antibiotics as first-line therapy for acute appendicitis: evidence for a change in clinical practice. World J Surg, 36(9), 2028-2036. doi: 10.1007/s00268-012-1641-x
Kang, J. H., Chen, Y. H., & Lin, H. C. (2010). Comorbidities amongst patients with multiple sclerosis: a population-based controlled study. Eur J Neurol, 17(9), 1215-1219. doi: 10.1111/j.1468-1331.2010.02971.x
Kang, J. H., & Lin, H. C. (2010). Comorbidities in patients with primary Sjogren''s syndrome: a registry-based case-control study. J Rheumatol, 37(6), 1188-1194. doi: 10.3899/jrheum.090942
Kao, L. T., Chiu, Y. L., Lin, H. C., Lee, H. C., & Chung, S. D. (2016). Prevalence of chronic diseases among physicians in Taiwan: a population-based cross-sectional study. BMJ Open, 6(3), e009954. doi: 10.1136/bmjopen-2015-009954
Khairy, G. (2009). Acute appendicitis: is removal of a normal appendix still existing and can we reduce its rate? Saudi J Gastroenterol, 15(3), 167-170. doi: 10.4103/1319-3767.51367
Kim, K. B., Song, D.H., & Park H. J. (2016). Automatic Extraction of Appendix from Ultrasonography with Self-Organizing Map and Shape-Brightness Pattern Learning. Biomed Res, 2016, 5206268. doi: 10.1155/2016/5206268
Kim, S. H., Park, S. J., Park, Y. Y., & Choi, S. I. (2015). Delayed Appendectomy Is Safe in Patients With Acute Nonperforated Appendicitis. Int Surg, 100(6), 1004-1010. doi: doi:10.9738/INTSURG-D-14-00240.1
Liang, T. J., Liu, S. I., Tsai, C. Y., Kang, C. H., Huang, W. C., Chang, H. T., & Chen, I. S. (2016). Analysis of Recurrence Management in Patients Who Underwent Nonsurgical Treatment for Acute Appendicitis. Medicine (Baltimore), 95(12), e3159. doi: 10.1097/md.0000000000003159
Lin, K. B., Lai, K. R., Yang, N. P., Chan, C. L., Liu, Y. H., Pan, R. H., & Huang, C. H. (2015). Epidemiology and socioeconomic features of appendicitis in Taiwan: a 12-year population-based study. World J Emerg Surg, 10, 42. doi: 10.1186/s13017-015-0036-3
Liu, Z. H., Li, C., Zhang, X. W., Kang, L., & Wang, J. P. (2014). Meta-analysis of the therapeutic effects of antibiotic versus appendicectomy for the treatment of acute appendicitis. Exp Ther Med, 7(5), 1181-1186. doi: 10.3892/etm.2014.1584
Ma, K. W., Chia, N. H., Yeung, H. W., & Cheung, M. T. (2010). If not appendicitis, then what else can it be? A retrospective review of 1492 appendectomies. Hong Kong Med J, 16(1), 12-17.
Mason, R. J. (2008). Surgery for appendicitis: is it necessary? Surg Infect (Larchmt), 9(4), 481-488. doi: 10.1089/sur.2007.079
McBurney C.(1891). The indications for early laparotomy in appendicitis. Ann Surg,;13, 233–254.
Park, H. C., Kim, M. J., & Lee, B. H. (2014). The outcome of antibiotic therapy for uncomplicated appendicitis with diameters Pisano, M., Coccolini, F., Poiasina, E., Bertoli, P., Giulii Capponi, M., Poletti, E., . . . Ansaloni, L. (2013). Conservative treatment for uncomplicated acute appendicitis in adults. Emergency Medicine and Health Care, 1(1). doi: 10.7243/2052-6229-1-2
Rehman, H., Rao, A. M., & Ahmed, I. (2011). Single incision versus conventional multi-incision appendicectomy for suspected appendicitis. Cochrane Database of Systematic Reviews(7). doi: 10.1002/14651858.CD009022.pub2
Sallinen, V., Akl, E. A., You, J. J., Agarwal, A., Shoucair, S., Vandvik, P. O., . . . Tikkinen, K. A. O. (2016). Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis. British Journal of Surgery, 103(6), 656-667. doi: 10.1002/bjs.10147
Salminen, P., Paajanen, H., Rautio, T., Nordstrom, P., Aarnio, M., Rantanen, T., . . . Gronroos, J. M. (2015). Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial. Jama, 313(23), 2340-2348. doi: 10.1001/jama.2015.6154
Styrud, J., Eriksson, S., Nilsson, I., Ahlberg, G., Haapaniemi, S., Neovius, G., . . . Granström, L. (2006). Appendectomy versus Antibiotic Treatment in Acute Appendicitis. A Prospective Multicenter Randomized Controlled Trial. World Journal of Surgery, 30(6), 1033-1037. doi: 10.1007/s00268-005-0304-6
Svensson, J. F., Patkova, B., Almstrom, M., Naji, H., Hall, N. J., Eaton, S., . . . Wester, T. (2015). Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Ann Surg, 261(1), 67-71. doi: 10.1097/sla.0000000000000835
Tsai, M. C., Lin, H. C., & Lee, C. Z. (2016). Diabetes increases the risk of an appendectomy in patients with antibiotic treatment of noncomplicated appendicitis. Am J Surg. doi: 10.1016/j.amjsurg.2016.07.026
Tashiro, J., Einstein, S. A., Perez, E. A., Bronson, S. N., Lasko, D. S., & Sola, J. E. (2016). Hospital preference of laparoscopic versus open appendectomy: Effects on outcomes in simple and complicated appendicitis. J Pediatr Surg. doi: 10.1016/j.jpedsurg.2016.02.028
van Rossem, C. C., Schreinemacher, M. H. F., Treskes, K., van Hogezand, R. M., & van Geloven, A. A. W. (2014). Duration of antibiotic treatment after appendicectomy for acute complicated appendicitis. British Journal of Surgery, 101(6), 715-719. doi: 10.1002/bjs.9481
Varadhan, K. K., Neal, K. R., & Lobo, D. N. (2012). Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials. BMJ, 344. doi: 10.1136/bmj.e2156
Vons, C., Barry, C., Maitre, S., Pautrat, K., Leconte, M., Costaglioli, B., . . . Franco, D. (2011). Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Lancet, 377(9777), 1573-1579. doi: 10.1016/s0140-6736(11)60410-8
Williams, G. R. (1983). Presidential Address: a history of appendicitis. With anecdotes illustrating its importance. Ann Surg, 197(5), 495-506.
Wilms, I. M. H. A., de Hoog, D. E. N. M., de Visser, D. C., & Janzing, H. M. J. (2011). Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database of Systematic Reviews(11). doi: 10.1002/14651858.CD008359.pub2
Wu, J. X., Dawes, A. J., Sacks, G. D., Brunicardi, F. C., & Keeler, E. B. (2015). Cost effectiveness of nonoperative management versus laparoscopic appendectomy for acute uncomplicated appendicitis. Surgery, 158(3), 712-721. doi: 10.1016/j.surg.2015.06.021
Wilms, I. M. H. A., de Hoog, D. E. N. M., de Visser, D. C., & Janzing, H. M. J. (2011). Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database of Systematic Reviews(11). doi: 10.1002/14651858.CD008359.pub2