妊娠合并急性阑尾炎100例临床研究  

Clinical study of 100 cases of suspected pregnancy complicated with acute appendicitis

作　　者：鲁珊 姚蕴珊 廖色坭 陈子恩 张一剑 蓝健皓 魏薇 刘艳杨 陈艳红[3] 陈敦金[3] Lu Shan;Yao Yunshan;Liao Seni;Chen Zien;Zhang Yijian;Lan Jianhao;Wei Wei;Liu Yanyang;Chen Yanhong;Chen Duijin(Department of Obstetrics and Gynecology,Anshun Maternal and Child Health Hospital,Anshun 561000,China;The NanShan College of Guangzhou Medical University,Guangzhou 511436,China;Department of Obstetrics and Gynecology,The Third Affiliated Hospital of Guangzhou Medical University,Guangzhou Medical Center for Gitical Pregnant Women,Key Laboratory for Major Obstetric Diseases of Guangdong Province,Guangzhou 510150,China;Department of Obstetrics and Gynecology,The Fourth Affiliated Hospital of Zhejiang University School of Medicine,Yiwu 322000,China;The Third Clinical College of Guangzhou Medical University,Guangzhou 510182,China)

机构地区：[1]安顺市妇幼保健院妇产科,安顺561000 [2]广州医科大学南山学院,广州511436 [3]广州医科大学附属第三医院妇产科、广东省产科重大疾病重点实验室、广东省妇产疾病临床医学研究中心粤港澳母胎医学高校联合实验室,广州510150 [4]浙江大学医学院附属第四医院妇产科,义乌322000 [5]广州医科大学第三临床学院,广州510182

出　　处：《中华产科急救电子杂志》2024年第4期214-219,共6页Chinese Journal of Obstetric Emergency（Electronic Edition）

基　　金：国家自然科学基金重点项目(81830045);广州市科技计划市校(院)联合资助项目(202102010005)。

摘　　要：目的探讨妊娠合并急性阑尾炎的临床特征、诊断、治疗方式及围产结局。方法收集2008年1月1日至2023年12月31日16年间广州医科大学附属第三医院妇产科收治的100例妊娠合并急性阑尾炎住院患者的临床资料,对其临床症状与体征、辅助检查、治疗方式及围产结局进行回顾性分析;按发病孕周不同,将100例患者分为早孕组(<14周,19例),中孕组(14~27+6周,43例),晚孕组(≥28周,38例)。结果(1)临床症状与体征:100例患者均以腹痛就诊(100.00%),其中88例有右下腹压痛(88.00%),66例有反跳痛(66.00%),三组孕妇的临床症状与体征差异均无统计学意义(P>0.05)。(2)辅助检查:三组孕妇白细胞数、中性粒细胞计数、降钙素原差异无统计学意义(P>0.05),晚孕组孕妇中性粒细胞百分比(86.4%)高于早孕组(80.3%),差异有统计学意义(Z=6.890,P<0.05);67例行腹部彩色多普勒超声(彩超)检查,11例行磁共振成像(magnetic resonance imaging,MRI)检查,2例行CT检查,16例行腹部彩超+MRI检查,4例行腹部彩超+CT检查,三组孕妇的腹部超声、腹部CT或MRI诊断率差异均无统计学意义(P>0.05)。(3)治疗方式与围产结局:手术治疗64例,药物保守治疗36例;在本院排胎和分娩的有54例,其中流产7例(12.96%)、阴道分娩18例(33.33%)、剖宫产29例(53.71%),早孕组(2例,2/8)、中孕组(6例,6/15)的剖宫产率显著低于晚孕组(21例,87.5%)孕妇,差异有统计学意义(χ^(2)=14.309,P<0.05),晚孕组孕妇的未足月分娩率(14例,58.33%)高于早孕(2例,2/8)、中孕组(0),差异有统计学意义(χ^(2)=15.631,P<0.05);47例在本院出生的新生儿窒息率,三组比较差异无统计学意义(P>0.05)。结论掌握不同孕周妊娠合并急性阑尾炎的临床特点,做到早期正确诊断和治疗,对改善围产结局有重要意义。Objective To investigate the clinical characteristics,diagnosis,treatment,and pregnancy outcome of pregnancy complicated with acute appendicitis.Methods A retrospective study was conducted on 100 pregnant women with Suspected acute appendicitis.The patients were admitted to the Third Affiliated Hospital of Guangzhou Medical University from January 2008 to September 2023.Clinical characteristics,diagnosis,treatment,and pregnancy outcome of the patients were analyzed.According to the onset of gestational age,100 patients were divided into the early-pregnancy group(<14 weeks)with 19 cases,the middle-pregnancy group(14-27+6 weeks)with 43 cases,and the late-pregnancy group(≥28 weeks)with 38 cases.Results(1)Clinical characteristics:All 100 patients presented with abdominal pain(100.00%),among which 88 cases had tenderness in the right lower abdomen(88.00%),and 66 cases had rebound pain(66.00%).There were no statistically significant differences in the clinical symptoms and signs among the three groups of pregnant women(P>0.05).(2)Auxiliary examination:There were no statistically significant differences in the white blood cell count,neutrophil count,and procalcitonin among the three groups of pregnant women(P>0.05).The percentage of neutrophils in the late-pregnancy group was higher than that in the early-pregnancy group,and the difference was statistically significant(86.4%vs 80.3%,Z=6.890,P<0.05).67 cases underwent abdominal color Doppler ultrasound examination,and 33 cases underwent CT or MRI examination.There was no statistically significant difference in abdominal ultrasound,abdominal CT or MRI among the three groups of pregnant women(P>0.05).74 cases underwent abdominal color Doppler ultrasound examination,11 cases underwent MRI examination,and 2 cases underwent CT examination.Additionally,16 cases received combined abdominal color Doppler ultrasound and MRI examinations,while 4 cases received combined abdominal color Doppler ultrasound and CT examinations.There were no statistically significant differences in t

关 键 词：妊娠 阑尾炎 腹痛 诊断 治疗学 妊娠结局 

分 类 号：R714.2[医药卫生—妇产科学]