Prodromidou Anastasia, Machairas Nikolaos, Kostakis Ioannis D, Molmenti Ernesto, Spartalis Eleftherios, Kakkos Athanasios, Lainas Georgios T, Sotiropoulos Georgios C
Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
Eur J Obstet Gynecol Reprod Biol. 2018 Jun;225:40-50. doi: 10.1016/j.ejogrb.2018.04.010. Epub 2018 Apr 9.
Acute appendicitis is the most prevalent cause of non-obstetrical surgical disease during pregnancy. There is no consensus on the optimal surgical management of acute appendicitis in pregnancy. Our aim is to identify surgical and obstetrical outcomes of laparoscopic (LA) and open approach (OA) in pregnant patients with acute appendicitis.
Medline, Scopus, Google Scholar, Cochrane CENTRAL Register of Controlled Trials and Clinicaltrials.gov databases were searched for articles published up to May 2017, along with the references of all articles. Prospective and retrospective trials reporting outcomes among pregnant women undergoing laparoscopic and open appendectomy were included. Of the 493 records screened, 20 were eligible for meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Statistical meta-analysis was performed using the RevMan 5.3 software.
A total of 6210 pregnant women from twenty studies were included in meta-analysis. Laparoscopic appendectomy was associated with significantly lower overall complication rates and shorter hospital stays (1835 patients OR 0.48 95% CI 0.29, 0.80 p = 0.005). While the open appendectomy group showed prolongation of gestational age for term deliveries, laparoscopic appendectomy patients had higher rates of fetal loss (543 patients MD -0.46 weeks 95% CI-0.87 to -0.04, p = 0.03 and 4867 patients OR 1.82 95% CI 1.30 to 2.57, p = 0.0006, respectively).
Current literature remains inconclusive on the optimal approach of appendectomy in pregnant women. Further larger-volume studies are needed in order to elucidate the critical effect of laparoscopic appendectomy on fetal loss rates.
急性阑尾炎是孕期非产科外科疾病最常见的病因。对于孕期急性阑尾炎的最佳手术治疗方法尚无共识。我们的目的是确定妊娠合并急性阑尾炎患者行腹腔镜手术（LA）和开腹手术（OA）的手术及产科结局。
检索了Medline、Scopus、谷歌学术、Cochrane对照试验中央注册库和Clinicaltrials.gov数据库中截至2017年5月发表的文章以及所有文章的参考文献。纳入报告行腹腔镜和开腹阑尾切除术的孕妇结局的前瞻性和回顾性试验。在筛选的493条记录中，20条符合荟萃分析的条件。遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。使用RevMan 5.3软件进行统计荟萃分析。
荟萃分析纳入了来自20项研究的共6210名孕妇。腹腔镜阑尾切除术与总体并发症发生率显著降低和住院时间缩短相关（1835例患者，OR 0.48，95%CI 0.29至0.80，p = 0.005）。虽然开腹阑尾切除术组足月分娩的孕周延长，但腹腔镜阑尾切除术患者的胎儿丢失率更高（543例患者，MD -0.46周，95%CI -0.87至-0.04，p = 0.03；4867例患者，OR 1.82，95%CI 1.30至2.57，p = 0.0006）。
目前的文献对于孕妇阑尾切除术的最佳方法仍无定论。需要进一步开展更大规模的研究，以阐明腹腔镜阑尾切除术对胎儿丢失率的关键影响。
