妊娠期急性复杂性阑尾炎诊断特征分析  

Diagnostic characteristics of acute complicated appendicitis during pregnancy

作　　者：王楠[1] 李响 李智飞[3] 李楠[4] 赵扬玉[1] 王妍[1] Wang Nan;Li Xiang;Li Zhifei;Li Nan;Zhao Yangyu;Wang Yan(Department of Obstetrics and Gynecology,Peking University Third Hospital,National Clinical Research Center for Obstetrics and Gynecology(Peking University Third Hospital),National Center for Medical Quality Management and Control of Obstetrics(Peking University Third Hospital),Beijing 100191,China;Department of General Medicine,Peking University Third Hospital,Beijing 100191,China;Department of General Surgery,Peking University Third Hospital,Beijing 100191,China;Clinical Epidemiology Centre,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院妇产科,国家妇产疾病临床医学研究中心,国家产科专业医疗质量管理与控制中心,100191 [2]北京大学第三医院全科医学科,100191 [3]北京大学第三医院普通外科,100191 [4]北京大学第三医院临床流行病中心,100191

出　　处：《中华普通外科杂志》2021年第11期841-845,共5页Chinese Journal of General Surgery

基　　金：国家重点研发计划(2019YFC0119704)。

摘　　要：目的探讨妊娠期急性复杂性阑尾炎(CAA)的诊断特征。方法对2007年8月至2018年8月北京大学第三医院收治的经手术治疗并且病理明确诊断的127例妊娠期急性阑尾炎患者的临床资料进行回顾性研究。根据病理结果将患者分为急性非复杂性阑尾炎(UCAA)组和CAA组,比较两组患者的临床特征。结果本组127例患者中CAA占37%。CAA组患者出现症状、体征以及辅助检查的阳性比例均高于UCAA组患者。ROC曲线分析结果显示,当症状开始到入院时间和外周血WBC计数临界值分别为15.5 h和17.11×10^(3)/mm^(3)时,诊断CAA的敏感性分别为76.6%和57.4%,特异性为75.0%和82.5%。症状开始到入院时间≥15.5 h(OR=8.435,95%CI:2.933~24.262)和外周血WBC计数>17.11×10^(3)/mm^(3)(OR=5.215,95%CI:1.626~16.729)是判断就诊时为CAA的独立危险因素。结论妊娠期阑尾炎的临床症状不典型,但CAA临床表现更重,当症状开始到入院时间超过15 h和外周血WBC计数超过17.11×10^(3)/mm^(3)时应高度怀疑CAA。Objective To analyze the diagnostic characteristics of complicated as acute appendicitis in pregnancy.Methods Data of pregnant patients who were treated surgically and diagnosed as acute appendicitis pathologically at the Third Hospital of Peking University from Aug 2007 to Aug 2018 were collected,including uncomplicated acute appendicitis(UCAA)such as simple and purulent appendicitis,and complicated acute appendicitis(CAA)(perforated,gangrenous appendicitis or periappendiceal abscess).Result There were 127 pregnant patients with acute appendicitis(47 CAA and 80 UCAA).CAA group had a higher proportion of positive symptoms,signs and examinations than UCAA group.ROC results showed that when pre-hospital time(the time from symptom onset to visiting the hospital,PT)and WBC critical values were 15.5 h and 17.11×10^(3)/mm^(3),respectively,the sensitivity of CAA were 76.6% and 57.4%,and specificity of CAA were 75.0% and 82.5%.PT≥15.5 h(OR=8.435,95%CI:2.933-24.262)and WBC>17.11×10^(3)/mm^(3)(OR=5.215,95%CI:1.626-16.729)were independent risk factors for CAA.Conclusion CAA in pregnancy is associated with atypical clinical features,but the clinical manifestations of CAA are more serious.When PT exceeds 15 h and WBC exceeds 17.11×10^(3)/mm^(3),CAA should be suspected and active operation should be suggested to avoid obstetric adverse outcomes.

关 键 词：阑尾炎 妊娠 白细胞计数 诊断 

分 类 号：R714.255[医药卫生—妇产科学]