妊娠合并急性阑尾炎30例诊疗分析

目的:探讨妊娠合并急性阑尾炎的诊治方法。方法:对2005年12月—2010年12月治疗的30例妊娠期急性阑尾炎患者的临床资料进行回顾性分析。结果:保守治疗14例,均为轻症妊娠早期、中期患者;手术治疗16例,1例术后流产,1例术后死胎,其他手术患者母儿预后均良好。妊娠晚期急性阑尾炎的体征不明显,但坏疽穿孔率高。结论:手术为妊娠晚期阑尾炎治疗的首要选择,多科室协作治疗是改善妊娠妇女及胎儿预后的首要条件。     

浅谈急性阑尾炎术后切口感染的原因及预防

目的：分析急性阑尾炎术后切口感染的相关因素。方法：回顾我院2000～2010年手术治疗的急性阑尾炎患者458例的临床资料,统计其中术后发生切口感染的患者例数,分析患者的性别、年龄、病程、手术时间、病理类型、切口类型以及术后引流情况与发生切口感染的关系。结果：急性阑尾炎术后切口感染的发生率为8%,其发生与性别、年龄无明显相关,而与病程、手术时间、病理类型、切口类型及术后引流情况有关。结论：临床上应注意改善急性阑尾炎术后切口感染的危险因素,降低术后切口感染的发生率,提高急性阑尾炎术后生活质量。     

妊娠合并急腹症69例的临床特点与妊娠结局

目的:探讨妊娠合并急腹症的临床特点及妊娠结局。方法:回顾分析2007年1月至2014年5月我院收治的69例妊娠合并急腹症患者的临床资料。结果:39例妊娠合并阑尾炎均行手术治疗,术后流产1例,早产2例,切口感染3例。9例合并急性胰腺炎,2例手术治疗,术后1例自行选择流产,1例自然流产;7例保守治疗成功。7例合并急性胆囊炎,保守治疗3例,4例行手术治疗,术后流产1例。5例合并肠梗阻,3例保守治疗,2例保守无效行手术治疗;4例合并泌尿系统结石,2例保守治疗,2例手术治疗。5例合并卵巢囊肿蒂扭转均行手术治疗,术后早产1例。所有病例中无孕产妇死亡,均痊愈出院,所有新生儿包括早产儿均存活。结论:早期诊断和积极有效干预有利于改善妊娠结局、提高临床疗效,确保母儿安全。     

急性阑尾炎手术的临床治疗分析

目的：探讨急性阑尾炎的发病机理及临床治疗的效果;方法：将近年来我院收治的50例急性阑尾炎患者治疗情况的临床资料随机进行分析研究,探讨急性阑尾炎患者手术治疗的临床效果;结果：50例急性阑尾炎患者经过手术治疗,其治疗的效果显著;结论：急性阑尾炎发病初期要早诊断,早发现,早治疗,防止发生并发症,手术后要注意并发症,通过手术治疗并注意休养病情会得到治愈。     

剖宫产术后急性结肠假性梗阻7例诊治分析

目的：研究剖宫产术后急性结肠假性梗阻的临床特点、发病因素，探讨早期诊断、治疗及预防措施。方法：回顾性分析1996年9月至2002年9月7例急性结肠假性梗阻患者的临床资料。结果：全组均为子宫下段剖宫产术后患者，于术后1--3天发病，呈进行性腹胀腹痛，1例误诊行剖腹探查，术中行肠减压术，余保守治疗，全部治愈出院。结论：手术刺激、妊娠、产程延长和妊高征等可诱发本病，早诊断是治疗的关键。     

误诊为急性阑尾炎的右侧输卵管积脓2例分析

目的：分析右侧输卵管积脓误诊为急性阑尾炎的临床诊断。方法：回顾分析2例右侧输卵管积脓误诊为急性阑尾炎的临床资料,总结具体的诊断方法。结果：2例患者均经具体诊断治疗后痊愈出院。结论：作为临床医生,一定要详细询问患者妇科相关病史及做妇科检查,做出正确判断,尽量避免误诊。     

多排螺旋CT对不典型急性阑尾炎的临床诊断观察

目的：探讨多排螺旋CT及多平面创建（MPR）对不典型急性阑尾炎的临床诊断价值。方法：选取我院收治的40例疑似急性阑尾炎并进行手术患者的CT及临床资料进行回顾性分析。结果：本组40例患者中2例患者术后阑尾病理结果为正常,1例患者CT未显示阑尾穿孔,其余37例患者CT诊断结果均和手术结果相符,其诊断符合率为92．5％。结论：多排螺旋CT及MPR结合应用于急性阑尾炎的诊断中可清晰地显示阑尾本身、阑尾周围情况及并发症,同时还可对邻近脏器的病变情况进行显示,具有较高的诊断价值,值得推广和应用。     

妊娠期急性胰腺炎的诊治分析

目的:探讨妊娠期急性胰腺炎(AP)的诊断和治疗特点。方法:回顾性分析我院2000年3月至2005年7月收治的7例妊娠期AP患者临床资料。结果:4例轻症AP保守治疗痊愈,继续妊娠;重症AP 3例,2例保守治疗后病情加重,剖宫产终止妊娠,同时行腹腔灌洗引流和胰腺及胆道手术,新生儿均成活,1例孕31周,发病4天胎死宫中,引产分娩,继续保守治疗,3例重症AP孕妇均痊愈。结论:血淀粉酶测定、B超或CT检查对诊断妊娠期AP有重要价值;妊娠期轻症AP保守治疗效果好,妊娠期重症AP适时终止妊娠,可确保母婴安全。     

妊娠合并急性阑尾炎的诊治——保守与手术？

急性阑尾炎是妊娠期最常见的外科合并症，其临床表现和体征往往不典型，容易漏诊而延误治疗时机，导致不良母胎结局，且目前对于妊娠合并急性阑尾炎的治疗尚存争议。文章从妊娠合并急性阑尾炎的诊断、手术治疗以及保守治疗策略等方面进行了阐述。     

急性阑尾炎采用外科手术与中药联合治疗临床体会

目的：评价分析外科手术联合中药对急性阑尾炎的治疗效果,旨在为提高急性阑尾炎手术的临床疗效提供有效指征。方法：选取自2011年5月至2013年5月在我院接受临床治疗的急性阑尾炎患者120例,以奇偶分组法将其随机分为对照组与治疗组,其中对照组患者予以外科手术治疗,治疗组患者予以外科手术联合中药疗法,记录两组患者临床治疗效果与并发症发生情况,进而对联合治疗的应用情况进行有效评估。结果：两组患者均顺利完成手术治疗。其中对照组患者有效率88．3％,治疗组有效率93．3％,比较无显著差异;但治疗组患者术后排气时间、住院时间均明显短于对照组,且治疗组并发症发生率仅为3．3％,明显低于对照组15．0％,P〈0．05,具有统计学差异。结论：外科手术联合中药疗法对急性阑尾炎的临床治疗有显著价值,在保证临床疗效的同时,可以显著提升康复质量,值得临床推广。     

Appendicitis in pregnancy: diagnosis, management and complications.

BACKGROUND: Acute appendicitis is the most common surgical emergency in pregnancy. The purpose of this study is to investigate the clinical presentation, management and outcome in patients who underwent appendectomy during pregnancy. MATERIAL AND METHODS: The case records of 56 women who underwent appendectomy during pregnancy between January 1985 and December 1997 were reviewed and analyzed. RESULTS: The incidence of appendicitis in pregnancy was one in 766 births. The preoperative diagnosis was correct in 75% of the cases. Uterine contractions and a history of diffuse or periumbilical pain migrating to the right lower abdominal quadrant were significantly more frequent among women with appendicitis compared to those patients where the appendectomy revealed a normal appendices. Abdominal pain, nausea, vomiting, leukocyte count, CRP and body temperature were not helpful in establishing the correct diagnosis. There was no maternal morbidity related to the appendectomy. Pregnancy complications were found to be considerable: 4/12 (33%) who underwent appendectomy for appendicitis during the first trimester aborted spontaneously. Second trimester appendectomy for appendicitis was followed by premature delivery in 4/28 (14%). However, no pregnancy complications were observed following third trimester appendectomy for appendicitis. We found no increase in pregnancy complications in cases with perforated appendicitis. CONCLUSION: Appendicitis in pregnancy should be suspected when a pregnant woman complains of new abdominal pain. No laboratory finding was found to be diagnostic for acute appendicitis during pregnancy. Considerable fetal loss was found after appendectomy during pregnancy in the first and second trimester. No increase in pregnancy complications in cases with perforated appendicitis was observed. The combination of symptoms and clinical judgement is still vital in deciding which patient needs surgical treatment. Based on the results in the present study we recommend prophylactic antibiotic treatment in all laparotomies during pregnancy when appendicitis is suspected.     

孕期非产科手术87例围手术期管理及妊娠结局分析

目的探讨孕妇在孕期行非产科手术时麻醉方式、手术因素及患者是否存在感染对母胎的影响。 方法回顾性分析广州医科大学附属第三医院2015年1月至2018年8月收治的87例因非产科疾病行手术治疗孕妇的临床资料,分析患者疾病分类、最终分娩孕周、分娩方式、早产及流产率等妊娠结局,比较不同孕期、不同手术方式、麻醉方式及感染并发症对妊娠结局的影响。 结果87例患者疾病分类：急性阑尾炎35例(40.2%),宫内妊娠合并宫外孕7例(8.1%),卵巢囊肿蒂扭转9例(10.3%),卵巢肿物21例(24.1%),泌尿系结石13例(14.9%),胆囊结石2例(2.3%);不同孕期接受非产科手术孕妇妊娠结局比较,差异无统计学意义(P>0.05);不同手术方式孕妇的分娩孕周、分娩方式、流产率、早产率等方面比较,差异无统计学意义(P>0.05);椎管内麻醉及全身麻醉在分娩方式、分娩孕周、早产及流产等方面比较,差异无统计学意义(P>0.05)。孕妇合并感染对妊娠结局有影响,孕妇合并感染情况对妊娠结局有影响,感染组分娩孕周低于对照组[(34.7±0.7)周与(38.5±0.2)周,Z＝5.088,P<0.05]。感染组剖宫产率、早产率和流产率均高于对照组[41.7% (10/24)与31.7% (20/63), χ²＝7.585;50% (12/24)与7.9% (5/63), χ²＝19.588;50.0% (12/24)与0, χ²＝29.659;P值均<0.05]。 结论孕期行非产科手术仍然可以获得较满意的妊娠结局,对于病情稳定的患者,不同孕期进行手术、不同麻醉方式和不同手术方式对妊娠结局影响没有差别,但对于合并感染的患者,病情本身的进展可能会影响妊娠结局。     

宫内外复合妊娠腹腔镜手术治疗34例分析

目的:探讨宫内外复合妊娠(HP)腹腔镜治疗的有效性、安全性及对妊娠结局的影响。方法:回顾性分析2011年1月—2018年1月天津市中心妇产科医院收治的宫内妊娠合并输卵管妊娠共34例,探讨腹腔镜手术治疗的可行性和妊娠结局。结果:34例患者均为宫内妊娠合并单侧输卵管妊娠,其中特殊病例包括:宫内双胎妊娠合并右侧输卵管妊娠1例,宫内妊娠合并右侧输卵管间质部妊娠1例,双子宫右侧宫腔妊娠合并左侧输卵管妊娠1例。所有患者均行腹腔镜手术治疗,手术时间15～110 min,平均(45.21±8.33)min;术中出血5～200 m L,平均(33.04±10.12)m L,其中3例因术前腹腔出血超过800 mL行输血治疗。术后患者无发热、切口感染和术后并发症,超声检查提示宫内妊娠状态正常,患者恢复良好。除胚胎停育行人工流产1例和失访1例外,余33例新生儿(1例双胎妊娠分娩)均为活产,未见新生儿发育畸形。结论:对于妊娠早期的宫内妊娠合并单侧输卵管妊娠患者,腹腔镜手术去除输卵管异位妊娠安全有效,术后未增加医源性流产率及新生儿出生缺陷发生率。     

Uterine myoma in pregnancy

A review was made of the medical records of 76 patients with uterine myomas during pregnancy with the aim of studying the time and method of diagnosis, symptomatology, treatment, and outcome of pregnancy. In 11 patients (15%) myomectomy was performed during pregnancy. The frequency of abortion was 18% in patients treated both conservatively and with myomectomy. Myomectomy during pregnancy is discouraged in the literature. In cases where conservative treatment cannot be practised it seems that the risk of spontaneous abortion during pregnancy is not significantly increased when myomectomy is performed.     

425例妊娠合并卵巢肿瘤患者的诊治分析

目的:探究分析妊娠合并卵巢肿瘤的病理和诊治特点,以及不同手术方式对妊娠结局的影响。方法:以南方医科大学附属深圳市妇幼保健院2010年9月—2016年9月收治的425例妊娠期卵巢肿瘤患者为研究对象,回顾性分析其临床资料,包括发现时间、病理类型、手术方式以及妊娠结局等。结果:妊娠期卵巢肿瘤患者中,囊性成熟性畸胎瘤是最常见的病理类型,其次是子宫内膜异位囊肿及黏液性囊腺瘤;妊娠期有30例(7.10%)患者发生并发症,其中蒂扭转最常见,其次是恶变及破裂出血;妊娠期卵巢肿瘤手术主要有腹腔镜和开腹手术2种,腹腔镜组的失血量([39.62±28.25)mL vs.(68.50±33.60)mL,t=2.563,P=0.015]、住院时间([6.46±2.03)d vs.(9.90±1.92)d,t=4.925,P<0.001]均小于开腹组。此外,腹腔镜组的平均手术孕周也小于开腹组([12.71±3.71)周vs.(16.71±4.89)周,t=2.490,P=0.018]。而2组之间的剖宫产率、低出生体质量儿发生率、早产率和流产率比较,差异均无统计学意义(均P>0.05)。妊娠期恶性肿瘤在及时且个体化的处理后预后较好。结论:妊娠期卵巢肿瘤需首先排除恶性可能,早发现、早处理预后较好。妊娠期手术治疗是安全的,推荐有手术指征者选择手术干预。腹腔镜和开腹手术对妊娠结局影响均较小,可以个体化选择手术方式。     

Acute cholecystitis in pregnancy

Thirty cases of acute cholecystitis in pregnancy were identified during a 12-year period. Twenty-one patients were successfully managed with medical therapy alone. Nine underwent surgical intervention, four after failing medical therapy and five as the initial approach to therapy. Surgical therapy was complicated by preterm labor and delivery in two patients undergoing surgery during the early third trimester. One patient underwent cholecystectomy during the first trimester and subsequently aborted. There were no serious complications in patients undergoing surgery during the second trimester. These data suggest that conservative medical management can be successfully used in most patients with acute cholecystitis in pregnancy.     

Laparotomy performed in pregnant women due to non-obstetrical causes

OBJECTIVE: The clinical characteristics of laparotomy during pregnancy were investigated. MATERIALS AND METHODS: A series of 24 cases of laparotomy during pregnancy was investigated with respect to clinicopathologic features and outcome. RESULTS: Among 23 cases there were 20 ovarian tumors, 2 acute appendicitis and 2 uterine fibroid. Gestational ages at the time of surgery ranged from 16 to 24 weeks of patients with ovarian tumors and from 30 to 32 weeks in others. No intraoperative or postoperative maternal or fetal complications occurred. One patient had a stage III ovarian carcinoma and went to total hysterectomy, and other patient had a stage IA ovarian carcinoma. CONCLUSIONS: Appendectomy can be performed without additional risk to the fetus for those who require surgical intervention during pregnancy. Ovarian surgery in pregnancy for persistent masses is important to obtain a final histologic diagnosis.     

Acute pancreatitis and pregnancy--analysis of a 10 year period of time

Acute pancreatitis during pregnancy is rare and complicates one in 1000 to 5000 pregnancies. The commonest reasons during pregnancy are: biliary disease, congenital or acquired hypertriglyceridemia and very rarely acute pancreatitis is associated with preeclampsia-eclampsia or HELLP syndrome. We presented in the research the clinical course of 14 women who developed acute pancreatitis and were treated at the Clinic of Thoraco-abdominal and Hepato-Biliary Surgery at the University Hospital Plovdiv for a tenth year of a period. The leading etiology was biliary disease. Eleven of 14 patient were successfully treated conservatively during pregnancy; 5 of them underwent surgery after pregnancy. Only one patient underwent operative treatment during pregnancy. Although acute pancreatitis is a rare disease during pregnancy, in order to improve the prognosis and to decrease the maternal and fetal morbidity and mortality, a timely diagnosis and an adequate conservative or surgical treatment is necessary.     

腹腔镜治疗异位妊娠85例临床分析

目的:探讨电视腹腔镜治疗异位妊娠的安全性、优越性。方法:回顾2008.1-2010.6我院收治的异位妊娠患者,其中85例采用腹腔镜治疗,与同期45例开腹手术相比较,根据妊娠部位及患者有无生育要求及盆腔具体情况,采用不同手术方式。结果:85例腹腔镜手术均获成功,无一例中转开腹。两组病人在年龄、腹部手术史、慢性盆腔炎史,无明显差异;比较两组手术时间、术中出血量、术后排气时间、术后镇痛时间及住院时间,两组有显著差异。结论:腹腔镜治疗异位妊娠是一种理想手术方式,是安全的,且不需要进腹,腹部无疤痕,术后粘连少,对需要以后多次手术的尤为适用。     

Live birth after laparotomy for concurrent heterotopic pregnancy and appendicitis in a 6 weeks IVF pregnancy

Backround A term delivery after concurrent appendectomy and salpingectomy at 6 weeks in an appendicitis coexisting with a heterotopic pregnancy after in vitro fertilization (IVF) treatment is reported. Methods Case report. Results The patient presented with severe low abdominal pain at 6 weeks of pregnancy after IVF and had explorative laparotomy for appendicitis, during which she had appendectomy and salpingectomy for an undiagnosed concurrent heterotopic pregnancy. The patient delivered a 3,960 g healthy infant at 38 weeks. Conclusion In patients with severe abdominal pain after IVF, appendicitis and heterotopic pregnancy should be included in the differential diagnosis. A dual pathology is possible and when treated appropriately it can result in survival of the precious intrauterine pregnancy. This is the second and earliest ever reported case of that resulted in live birth. It shows that explorative surgery must be performed timely in acute abdomen in pregnancy.