Bouyou J, Gaujoux S, Marcellin L, Leconte M, Goffinet F, Chapron C, Dousset B
Service de chirurgie digestive, hépatobiliaire et endocrinienne, Hôpital Cochin, AP-HP, Paris, France.
Service de chirurgie digestive, hépatobiliaire et endocrinienne, Hôpital Cochin, AP-HP, Paris, France; Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
J Visc Surg. 2015 Dec;152(6 Suppl):S105-15. doi: 10.1016/j.jviscsurg.2015.09.017. Epub 2015 Oct 30.
Abdominal emergencies during pregnancy (excluding obstetrical emergencies) occur in one out of 500-700 pregnancies and may involve gastrointestinal, gynecologic, urologic, vascular and traumatic etiologies; surgery is necessary in 0.2-2% of cases. Since these emergencies are relatively rare, patients should be referred to specialized centers where surgical, obstetrical and neonatal cares are available, particularly because surgical intervention increases the risk of premature labor. Clinical presentations may be atypical and misleading because of pregnancy-associated anatomical and physiologic alterations, which often result in diagnostic uncertainty and therapeutic delay with increased risks of maternal and infant morbidity. The most common abdominal emergencies are acute appendicitis (best treated by laparoscopic appendectomy), acute calculous cholecystitis (best treated by laparoscopic cholecystectomy from the first trimester through the early part of the third trimester) and intestinal obstruction (where medical treatment is the first-line approach, just as in the non-pregnant patient). Acute pancreatitis is rare, usually resulting from trans-ampullary passage of gallstones; it usually resolves with medical treatment but an elevated risk of recurrent episodes justifies laparoscopic cholecystectomy in the 2nd trimester and endoscopic sphincterotomy in the 3rd trimester. The aim of the present work is to review pregnancy-induced anatomical and physiological modifications, to describe the main abdominal emergencies during pregnancy, their specific features and their diagnostic and therapeutic management.
孕期腹部急症（不包括产科急症）在500 - 700次妊娠中会出现1例，可能涉及胃肠道、妇科、泌尿科、血管和创伤等病因；0.2% - 2%的病例需要进行手术。由于这些急症相对罕见，患者应转诊至具备外科、产科和新生儿护理条件的专业中心，特别是因为手术干预会增加早产风险。由于妊娠相关的解剖和生理改变，临床表现可能不典型且具有误导性，这常常导致诊断不确定和治疗延迟，增加母婴发病风险。最常见的腹部急症是急性阑尾炎（最佳治疗方法是腹腔镜阑尾切除术）、急性结石性胆囊炎（从孕早期到孕晚期早期，最佳治疗方法是腹腔镜胆囊切除术）和肠梗阻（与非孕期患者一样，药物治疗是一线治疗方法）。急性胰腺炎很少见，通常由胆结石经壶腹通过引起；通常通过药物治疗可缓解，但复发风险升高使得在孕中期进行腹腔镜胆囊切除术以及在孕晚期进行内镜括约肌切开术是合理的。本研究的目的是回顾妊娠引起的解剖和生理改变，描述孕期主要的腹部急症、其特点以及诊断和治疗管理。
