妊娠期急性阑尾炎诊治的研究进展

妊娠期急性阑尾炎是最常见的非产科急腹症之一,可发生在孕期各阶段,以孕6个月内最为常见。由于妊娠的特殊生理及阑尾位置的变化,妊娠期急性阑尾炎的临床表现常不典型,在不同妊娠阶段的表现各异,其中在妊娠早期,其临床表现与非妊娠期相似,具有典型的麦氏点固定压痛;在妊娠中、晚期,阑尾向上外、向后移位,其症状及体征均不典型,易误诊、漏诊,延误病情而致阑尾穿孔、坏疽、胎儿流产、早产,甚至危及母婴的生命安全。另外,实验室检查不具备特异性,其确诊需要依靠影像学等辅助手段。超声、MRI均是其安全有效的影像学诊断手段,其中超声具备方便、快捷、安全等特性,作为初诊的首选影像学检查。手术是其首要的治疗手段,并应积极在发病24 h内进行,以降低胎儿、孕产妇病死率和相关并发症的发生率。根据手术路径的不同,手术方式可分为开腹手术及腹腔镜手术,然而,目前手术方式的最佳选择应基于现有的专业知识、术者经验、医疗设施、病情以及患者意向等因素。腹腔镜手术已被证实具备安全性及有效性,开腹手术仍占主导地位。

Research progress of the diagnosis and treatment for acute appendicitis during pregnancy

Acute appendicitis during pregnancy is one of the most common non-obstetric acute abdominal conditions,and it can occur at all stages of pregnancy,most frequently within the first 6 months of pregnancy.Due to the special physiological situation of pregnancy and the changes in the position of the appendix,the clinical manifestations of acute appendicitis during pregnancy are atypical,and highly variable at different stages of pregnancy.In the early pregnancy,the clinical manifestations are similar to those in the non-pregnancy period,with the typical sign of the localized tenderness over McBurney’s point;in the middle and late pregnancy,the appendix becomes displaced upwards laterally and backwards,and the symptoms and signs are nonspecific,which likely leads to misdiagnosis and missed diagnosis,and thereby cause appendiceal perforation or gangrene,fetal abortion,premature delivery,or even endanger the life of mother and baby due to delayed treatment.In addition,laboratory findings are nonspecific,and auxiliary examinations such as imaging are required for diagnosis.Both ultrasound and MRI are safe and effective imaging diagnostic modalities,in which,ultrasound has the characteristics of convenience,rapidness and safety,and is the first choice of imaging examination at the initial diagnosis.Surgery is the primary treatment method,and should be ideally performed within 24 h of the onset of symptoms,so as to reduce the maternal and infant mortality and incidence of the associated complications.According to the surgical approaches,the surgical procedures include traditional open surgery and laparoscopic surgery.However,the selection of surgical procedures at present should be based on the general factors that include the existing expertise,surgeon’s experience,medical facilities,disease status,and patients’ intention.Laparoscopic surgery has been proven to be safe and effective,and open surgery is still the dominant choice.