腹腔镜切除妊娠期阑尾的疗效分析

Analysis of curative effect of laparoscopic appendectomy during pregnancy

摘要:

目的 比较腹腔镜手术和开腹手术治疗妊娠期急性阑尾炎的优势和安全性。方法 回顾性分析2004年11月－2023年4月该院收治的22例早期妊娠、中期妊娠和晚期妊娠急性阑尾炎患者的临床资料。按不同手术方式分为腹腔镜组（n = 9）和开腹组（n = 13），比较两组患者感染指标和胎儿结局影响指标等。结果 两组患者住院时间、术中出血量、引流管放置率、术后C反应蛋白、降钙素原、抗生素使用时间、切口感染率、腹腔感染率、保胎治疗时间、病理学表现、早产率、分娩方式和胎儿存活率比较，差异均无统计学意义（P > 0.05）；腹腔镜组手术时间长于开腹组，术后镇痛剂使用时间、首次进食时间和肛门排气时间短于开腹组，术后白细胞计数低于开腹组，差异均有统计学意义（P < 0.05），两组患者麻醉方式比较，差异有统计学意义（P < 0.05）。结论 腹腔镜手术治疗妊娠期急性阑尾炎，安全可行，与开腹手术相比，具有切口小、切口美观、肠道功能恢复快、进食早、感染少、母胎结局好和胎儿安全性高等优点。

Abstract:

Objective To explore the advantages and safety of laparoscopic operation compared with open surgery for the treatment of acute appendicitis in pregnancy.Methods The clinical data of 22 patients with early, middle and late pregnancy acute appendicitis from November 2004 to April 2023 were retrospectively analyzed. They were divided into laparoscopic operation group (n = 9) and open group (n = 13) according to the operation method. The infection indicators and fetal outcome indicators were compared between the two groups.Results Comparison of hospitalization time, intraoperative bleeding, drain placement rate, C-reactive protein, procalcitonin, antibiotic use time, incision infection rate, abdominal infection rate, fertility preservation treatment time, pathological manifestations, preterm delivery rate, delivery mode, fetal survival rate between the two groups, the differences were not statistically significant (P > 0.05); the operation time of laparoscopic group was longer than that of open group, postoperative analgesic use time, postoperative time of first feeding and postoperative anal defecation time were shorter than those of open group, postoperative leukocyte count was lower than that of open group, the differences were all statistically significant (P < 0.05), and anesthesia mode was statistically significant (P < 0.05).Conclusion Laparoscopic surgery is safe and feasible for the treatment of appendicitis in pregnancy. Compared with laparotomy, it has the advantages of small incision, beautiful incision, fast intestinal recovery, early feeding, less infection, good maternal-fetal outcome and high fetal safety.