| Objective Acute appendicitis in pregnancy is one of the most intractable diseases.It is necessary to consider the special physiological and psychological status of pregnant women and fetal factors.It also needs to consider the condition of appendicitis,and the potential danger of the mother and child is increased due to the lack of timely and effective diagnosis and treatment.It is generally believed that pregnancy with acute appendicitis as early as the principle of surgery,but there is no lack of clinical cured through conservative treatment cases,there also have cases of conservative treatment ineffective.Therefore,under what circumstances can choiceconservative treatment;and under what circumstances should be operated as soon as possible,these are worth exploring.Methods A retrospective analysis of 2010.1-2016.6 in our hospital(gastrointestinal surgery,surgery of liver,biliary and pancreatic surgery,Department of thyroid and breast surgery)four were pregnancy and acute appendicitis cases,according to the inclusion criteria included 109 patients.According to the different treatment methods,they were divided into two groups: conservative treatment group and surgical treatment group(group C),including conservative treatment group(A group)and failure group(group B).Comparison of the three groups of clinical features,treatment effects,maternal complications,hospitalization time and cost,and further analysis of the reasons for the failure of conservative treatment and indications of surgical intervention.The standard of successful conservative treatment: the symptoms and signs disappeared,the hemogram returned to normal.Statistical methods using SPSS17.0 software to analyze the data packets of different levels,gestational age,body temperature,white blood cell patients count and neutrophil percentage and complications are expressed by N,compared with x~2 test;age,gestational age,body temperature,WBC and neutrophil count the percentage of cells,hospitalization time and cost by using((x|-)±S)said,compared with the t test,The significant level was unilateral in 0.05,P <0.05 had statistically significant difference can be considered.Results 1.This group of 109 patients,age 19~39 years old,with an average age of 27.4±4.5 years old,there are similar cases of appendicitis history in 4 cases.Primipara 76 cases.Gestational weeks in the 5~37 weeks,the average gestational age of 22.7±7.8 weeks,the early pregnancy(1~13 weekend)in the case of patients,accounting for 13.8%;in the second trimester(14~27 weekend)in the case of patients with a total of 57,accounting for 52.3%.of the patients in late pregnancy(28 weeks~)in 37 cases,accounting for 33.9%.The results showed that 24 cases of appendiceal lesions were diagnosed by abdominal ultrasonography,and the positive rate was about 22%.In these cases,there were 4 cases of appendiceal obstruction,all operations were performed.2.Clinical data of each group(1)Conservative treatment of 78 patients,including conservative treatment of success in 67 cases,failure in 11 cases a.Conservative treatment success group: 67 patients with the average course of 25.7±18.1h,abdominal ultrasonography was positive in 9 cases.With an average body temperature of 36.9±0.7?.The average WBC score of the first diagnosis was 14.9±4.5*109/L and the mean percentage of neutrophil was(85.2±6.6)%;Re-examination within 12 h,the average temperature is 36.7±0.8?,and the average WBC count was12.3±2.7*109/L and the average percentage of neutrophil was(79.9±5.5)%.There were 6 cases with new symptoms,42 cases with no symptoms or local signs change in abdomen,19 cases relieved,6 cases aggravated.The average length of hospital stay was 4.9±2.4 days,with an average cost of 4871.3±3050.9yuan;b.Conservative treatment failure group: 11 patients with an average course of disease of 42.1±25.9h,abdominal ultrasonography was positive in 5 cases,the cavity of the appendix was found to be blocked by fecal stone in 1 cases.At first treatment,with an average body temperature of 37.2±0.9?,the average number of WBC was 16.7±3.6*109/L and the average percentage of neutrophils was(88.3±3.7)%;in our hospital within 12 h recheck again the average temperature is 37.4±1.07?,the average number of WBC was15.9±2.2*109/L,the average percentage of neutrophils was(90.5±3.4)%.There were 4 cases with new symptoms accompanied by 3 cases of fever,4 cases with no symptoms or local signs change in abdomen,2 cases relieved and 5 cases aggravated.The average hospitalization was 9.3±6.5 days,the average cost of 23091.3±10332.6 yuan.(2)Treatment of 31 cases of patients underwent emergency surgery,the average course of 25.9±16.4h,the average temperature is 37.1±0.6?,the average number of WBC was 17.4±2.7*109/L,the average percentage of neutrophils(89.2±4.6)% in hospital the number of days 9.1±4.3 days,the average cost of 22251.9±9473.9 yuan.3.The results showed that the children of normal pregnancy were not abnormal.3.1.Conservative treatment a.Conservative treatment was successful in 67 cases,normal pregnancy in 62 cases,cesarean section and normal appendectomy in 2 cases.There were 0 cases of recurrence of appendicitis during pregnancy,and of 7 patients with recurrence after delivery,and the operation was performed in parallel in the same period.There were 4 cases of premature delivery,of which there were a total of 1 cases of abortion.b.Group of 11 cases of conservative treatment failed in 1 cases of cesarean section and appendectomy,others underwent appendectomy treatment,postoperative pathological examination showed 6 cases phlegmonous appendicitis,including 1 patients with appendix cavity bezoar obstruction;3 cases of appendix gangrene,2 cases of appendiceal perforation in the middle.2 cases of premature labor,including one case with incision infection,2 cases of abortion,the incision infection in 1 cases,postoperative vaginal bleeding in the 5 day after operation and adhesive intestinal obstruction in 1 month after operation in 1 cases.3.2Surgical treatment: 28 cases of normal pregnancy,the postoperative pathological examination showed that 6 cases were simple appendicitis,25 cases of cellulitis or suppurative appendicitis.There were 3 cases of incision infection in pregnant women,1 cases of adhesion obstruction in two months after operation,2 cases of premature birth and 1 cases of abortion.4.statistical analysis There was no significant difference in the age,body temperature,gestational age and mean neutrophil percentage among the conservative treatment group,the failure group and the surgery group(p>0.05).4.1.Analysis of conservative treatment success group and failure group single factor,course of disease >24h,N%>85%and the higher WBC review count and(or)percentage of neutrophils and other accompanying symptoms within 12 h,abdominal ultrasound showed the lumen bezoar obstruction as the risk factors of failure of conservative treatment.4.2.Compared with conservative treatment group(A)and surgical treatment group(C),the mean leukocyte level in group C was higher than that in group A(P=0.021),In A group,the number of WBC>16*109/L(23/67;23/31),the percentage of neutrophil number>85%(37/67;27/31),the overall abdominal ultrasound positive number(9/67,11/31),the second trimester ultrasound positive number(5/37,7/17)were less than C group,A group relative to the C group less hospitalization cost and shorter hospitalization time.There were no statistically significant differences in overall maternal and infant complications(12/67,7/31),and premature birth,abortion rate have no significant difference(x~2=0.14,p>0.05);4.3.Compared with conservative treatment failure group(B)and surgical treatment group(C),the overall maternal and infant complications,premature birth and abortion rate in group B were higher than those in group C(x~2=3.88,0.01<p<0.05).However,there was no significant difference in total maternal and neonatal complications(23/78,7/31)between the total conservative treatment group(A+B)and the surgery group(C)(x~2=0.53,p>0.05).Conclusions 1.Pregnancy complicated with acute appendicitis occurred in the second trimester of pregnancy(52.3%)and late(33.9%),and the number of primiparawas higher(69.7%).Among them,the incidence of pregnancy was higher in the 16 week,20 week and 32 week.2.the conservative treatment group was relatively low cost of operation,hospitalization time was shorter,the overall complication rate,premature delivery and abortion rate were without statistically different between the two groups.The total maternal complications and premature delivery,abortion rate of conservative treatment failure group were higher than those of surgical treatment.However,there was no difference in the overall maternal and neonatal complications in the conservative treatment group.3.When symptoms and signs are serious,WBC>16*109/L and(or)neutrophil percentage >85%,abdominal ultrasound have positive findings or positive in the second trimester of pregnancy,especially with fecal obstruction of the appendix,surgical treatment is recommended.Conversely,when symptoms and signs are mild,WBC<16*109/L and neutrophil percentage <85%,and abdominal ultrasound was negative,conservative treatment is recommended.4.Conservative treatment needs dynamic monitoring of body temperature,hemogram and abdominal ultrasound,and closely observe the changes of symptoms and signs.When the conservative treatment of 12 h,duration>24h,clinical symptoms or signs of aggravation,increased body temperature,or other accompanying symptoms appear,the count of WBC increased compared with the previous >16*109/L and(or)neutrophil percentage increased >85% than before,abdominal B ultrasound indicates appendicitis exacerbationwhen the surgery is recommended. |
PDF Full Text Request