妊娠期急性阑尾炎72例临床分析

Analysis of 72 pregnant patients with acute appendicitis

目的探讨妊娠期急性阑尾炎的临床特点、诊治方法和术后并发症。方法回顾性分析6年间72例妊娠期急性阑尾炎的临床资料。结果早期妊娠合并急性阑尾炎13例，中期47例，晚期12例。右下腹痛47例，右下腹压痛42例、反跳痛23例、肌紧张12例。B型超声征象异常31例（43％）。手术49例（68％），保守治愈23例（32％）。术后伤口感染3例（6％），腹腔残余脓肿1例（2％）。先兆流产或先兆早产19例，流产4例，早产2例。结论妊娠期急性阑尾炎及时诊治至关重要，诊断不明确者可作短暂观察，B型超声结果阳性能够确诊。抗生素保守治疗可选择性应用。保胎治疗对于非穿孔性阑尾炎效果明显，阑尾穿孔时早产和流产发生率明显增加。

Objective To evaluate the clinical presentation, diagnosis, management, and outcome of acute appendicitis in pregnancy. Methods Seventy-two cases of acute appendicitis in pregnancy were retrospectively analyzed. Results There were 13 cases at 1st trimester,27 at 2nd trimester, and 12 at 3rd trimester. Forty-seven cases complained of abdominal pain in right lower quadrant, and 42 cases had tenderness in the same area. Twenty-three cases had rebound tenderness and 12 cases had myotonia. Thirty-one cases （43 %） had abnormal findings of ultrosound. Forty-nine cases （68 %） received surgical operations and 23 cases （32 %） were given conservative treatment. Wound infection occurred in 3 cases （6 %） and abdominal abscess in one （2 %）. Nineteen cases developed threatened abortion or preterm contraction. Four cases progressed to abortion and 2 preterm delivery. Conclusion It is crucial to diagnose and manage acute appendicitis in pregnancy timely. Temporary observation is reasonable whenever the diagnosis is in doubt. Positive findings of ultrasound can confirm diagnosis. Antibiotics as conservative treatment could be applied selectively. Tocolytics has obvious effects on the patients with non-perforated appendicitis. The incidence of abortion and preterm delivery increases dramatically when appendix is perforated.