妊娠合并外科急腹症诊断与治疗

Diagnosis and treatment of pregnancy complicated with acute abdomen

目的总结妊娠合并外科急腹症的临床特点和诊治经验。方法回顾性分析2007年7月至2012年6月5年间我院妇产科与外科收治的48例妊娠合并外科急腹症病人临床资料。结果妊娠合并急性阑尾炎27例，4例经保守治愈，23例实施手术，流产1例，早产2例，无孕妇死亡。急性胆囊炎8例，5例急性结石性胆囊炎病人于中孕行腹腔镜胆囊切除术治愈，3例经保守治愈，均成功妊娠至分娩。急性胰腺炎6例，均保守治疗，流产2例，4例成功妊娠至分娩。泌尿系结石4例，经腹部超声确诊后2例保守治疗成功，2例行超声波体外碎石术。肠梗阻3例，非绞窄性肠梗阻2例，保守治疗成功；绞窄性肠梗阻1例，开腹手术治疗，术后流产。结论妊娠期外科急腹症具备一定的临床特点，妊娠不是手术干预的禁忌证，腹腔镜手术具有一定应用价值。对于妊娠合并急性阑尾炎应积极手术治疗，其他外科急腹症则应根据具体情况采取保守或手术在内的个体化治疗方案。保证孕妇和胎儿安全是各种治疗过程中均应遵循的重要原则。

Objective To investigate the clinical features, diagnosis and treatment of pregnancy complicated with acute abdomen. Methods Forty eight cases of prognancy complicated with acute ab- domen admitted between July 2007 and June 2012 at our hospital were retrospectively analyzed and the related literature was reviewed. Results Ultrasonographic imaging during pregnancy was safe and useful in identifying the etiology of acute abdominal pain in the pregnant women. Forty-eight cases consisted of 27 cases of acute appendicitis, 8 cases of cholecystitis, 6 cases of pancreatitis, 4 cases of uropoiesis calculus and 3 cases of intestinal obstruction. Conclusion The pregnancy is not surgical contraindication in the treatment of acute abdomen. Laparoscopic treatment of acute abdominal disease has the same indications in pregnant and non-pregnant patients. Surgical intervention should be done for acute appendicitis, and other acute abdominal diseases should be treated individually.