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目的探讨妊娠期合并急性阑尾炎的诊断与处理要点。方法总结分析武陟县大虹桥乡阳城卫生院1998年至2010年收治的29例妊娠期合并急性阑尾炎患者诊断、处理与手术治疗情况。结果 29例患者均行手术治疗,其中妊娠早期(<3个月)5例,妊娠中期(3～7个月)13例,妊娠晚期(8～10个月)11例;术后切口感染1例,妊娠转归:早产1例(婴儿成活),先兆流产2例(临床表现为术后阵发性腹痛和或阴道少量流血),足月分娩3例,其余继续妊娠。结论急性阑尾炎是妊娠期较常见的外科合并症,尤其妊娠中、晚期由于子宫增大较快,盲肠被子宫推压上移,腹壁被抬高,炎症阑尾刺激不到壁层腹膜,腹肌被伸直而使压痛、肌紧张和反跳痛等体征不明显,大网膜难以包裹炎症的阑尾,腹膜炎不易局限而易在腹腔内扩散,病程发展较快,如处理不及时易导致流产和早产,威胁母子安全,因此应及时手术治疗。
Objective To investigate the diagnosis and treatment of acute appendicitis during pregnancy. Methods The diagnosis, treatment and surgical treatment of 29 pregnant women with acute appendicitis during pregnancy from 1998 to 2010 in Yangcheng Hospital of Da Hong Qiao Township, Wudang County were summarized and analyzed. Results All the 29 patients underwent surgical treatment. Among them, 5 were in early pregnancy (<3 months), 13 in third trimester (3-7 months), and 11 in late trimester (8-10 months). Incision infection Cases, pregnancy outcome: 1 case of preterm birth (baby survival), threatened abortion in 2 cases (clinical manifestations of paroxysmal abdominal pain or vaginal bleeding), full-term delivery in 3 cases, the rest continue pregnancy. Conclusions Acute appendicitis is a common surgical complication during pregnancy. Especially in the late pregnancy, the uterus enlarges faster, the cecum is pushed up by the uterus, the abdominal wall is elevated, and the inflammatory appendice can not stimulate the parietal peritoneum. Straightening and tenderness, muscle tension and rebound tenderness and other signs is not obvious, difficult to wrap the omentum inflammation of the appendix, peritonitis is not easy to limit and easy to spread in the abdominal cavity, the course of development is rapid, such as improper handling lead to miscarriage and premature birth , Threatening the safety of mother and child, it should be timely surgical treatment.