妊娠期急性阑尾炎临床诊治分析

Clinical analysis of acute appendicitis during pregnancy

目的:探讨妊娠期急性阑尾炎临床表现特点及预后相关因素。方法:回顾分析我院收治的94例妊娠期急性阑尾炎患者的临床资料,总结其临床表现及理化检查特点,并分析术前指标与阑尾病理类型、术后并发症及意外终止妊娠的相关性。结果:典型的症状(右下腹痛)、体征(右下腹压痛)的患者分别占92.55%、94.68%。B超检查阳性率为51.06%,术前WBC计数水平平均(15.51±4.28)×10^(9)/L。复杂性阑尾炎发生率为30.85%,复杂性阑尾炎WBC计数水平较非复杂性阑尾炎高,差异有统计学意义[(17.04±4.35)×10^(9)/L vs.(14.83±4.09)×10^(9)/L,P<0.05]。复杂性阑尾炎发生率在发病第1、2、3天分别为10.00%、52.38%、11.34%,相互间差异均有统计学意义(P<0.05)。阑尾病理类型与患者年龄、B超结果、妊娠史及孕期无关(P>0.05)。总体并发症与意外终止妊娠发生率分别为9.57%、8.51%。术后并发症及意外终止妊娠发生率在发病第1、2天差异无统计学意义(3.33%vs.4.76%,1.67%vs.4.76%,P>0.05),在发病第3天时均明显升高(46.15%,46.15%),分别与第1、2天比较差异均有统计学意义(P<0.05)。术后并发症及意外终止妊娠与患者年龄、WBC水平、B超结果、妊娠史及孕期均无关(P>0.05)。结论:妊娠期急性阑尾炎的诊断目前仍主要依据典型的临床症状与体征,B超诊断价值有限,WBC水平可作为阑尾病理严重程度的参考。尽早手术可降低术后并发症及意外终止妊娠发生率。对于诊断困难患者,将发病2d作为观察期限是相对安全的。

Objective:To investigate the clinical features and prognostic factors of acute appendicitis during pregnancy.Methods:The clinical data of 94patients with acute appendicitis during pregnancy admitted to the First Hospital of the University of Science and Technology of China were retrospectively analyzed.The clinical manifestations and physical and chemical examination characteristics of these patients have been summarized.The correlation between the preoperative indicators and the pathological types of appendix,postoperative complications,and unexpected termination of pregnancy were analyzed.Results:Patients with typical symptoms(right lower abdominal pain)and signs(right lower abdominal tenderness)accounted for 92.55%and 94.68%,respectively.The positive rate of B-ultrasound was 51.06%.The average level of preoperative white blood cell(WBC)count is(15.51±4.28)×10^(9)/L.The incidence of complicated appendicitis was 30.85%.The WBC count level of complicated appendicitis was higher than that of uncomplicated appendicitis,and the difference was statistically significant[(17.04±4.35)×10^(9)/L vs.(14.83±4.09)×10^(9)/L,P<0.05].The incidence of complicated appendicitis on day 1,2,and 3were 10.00%,52.38%,92.31%,respectively,and the differences were statistically significant(P<0.05).The pathological type of the appendix had no correlation with the patient's age,B-ultrasound results,pregnancy history and gestational stages(P>0.05).The overall incidence of complications and unexpected termination of pregnancy were 9.57%and 8.51%,respectively.There was no significant difference in the incidence of postoperative complications and unexpected termination of pregnancy on the first and second days of the onset(3.33%vs.4.76%,1.67%vs.4.76%,P>0.05),and they were significantly higher on the third day of onset(46.15%,46.15%),compared with the first and second days of onset,the differences were statistically significant(P<0.05).Postoperative complications and unexpected termination of pregnancy were not related to the patient’s age,WBC level,B-ultrasound results,pregnancy history and gestational stages(P>0.05).Conclusion:The diagnosis of acute appendicitis during pregnancy is still mainly based on typical clinical symptoms and signs.The diagnostic value of B-ultrasound is limited.WBC level can be used as a reference parameter for the severity of appendix pathology.Early surgery can reduce the incidence of postoperative complications and unexpected termination of pregnancy.For suspected patients who have difficulty in diagnosis,clinical observation within 2days after the onset is relatively safe.