妊娠阑尾切除术：评估阴性阑尾切除术的风险。
Appendectomy in pregnancy: evaluation of the risks of a negative appendectomy.
机构信息
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
出版信息
Am J Surg. 2012 Feb;203(2):145-50. doi: 10.1016/j.amjsurg.2011.02.010. Epub 2011 Jul 23.
BACKGROUND
In pregnant women, a high negative appendectomy (NA) rate often is reported; however, the outcome of pregnancy after a NA is not well studied.
METHODS
Among 1,696 consecutive patients (728 men and 968 women) who underwent an appendectomy at our institution (1996-2005), 87 pregnant women were identified. Postoperative surgical and obstetric outcomes were analyzed based on the final pathologic report of the appendix (normal appendix, inflamed, or perforated).
RESULTS
The NA rate was significantly higher in pregnant women compared with nonpregnant women (36% vs 14%; P < .05). The fetal demise rate was similar between the NA group and the inflamed group (3% vs 2%; P = NS), and highest (14%) in the perforated group, although this difference did not reach statistical significance (P = .3). Wound infections were most frequent in the perforated group (P < .05).
CONCLUSIONS
NA during pregnancy is not free of risk to the fetus. We recommend careful assessment to avoid unnecessary exploration when appendicitis is suspected in pregnant women.
背景
在孕妇中，常报道有较高的阴性阑尾切除术（NA）率；然而，NA 后妊娠的结局尚未得到很好的研究。
方法
在我院（1996-2005 年）连续进行的 1696 例阑尾切除术中（728 例男性和 968 例女性），确定了 87 例孕妇。根据阑尾的最终病理报告（正常阑尾、发炎或穿孔），分析术后手术和产科结局。
结果
与非孕妇相比，孕妇的 NA 率明显更高（36% vs 14%；P<.05）。NA 组与发炎组的胎儿死亡发生率相似（3% vs 2%；P=NS），而穿孔组最高（14%），尽管这一差异无统计学意义（P=0.3）。穿孔组的伤口感染最常见（P<.05）。
结论
孕妇行 NA 并非对胎儿无风险。我们建议在怀疑孕妇患有阑尾炎时，应进行仔细评估，避免不必要的探查。
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