Frountzas M, Nikolaou C, Stergios K, Kontzoglou K, Toutouzas K, Pergialiotis V
Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens , Greece.
General Surgery, Watford General Hospital , Watford , UK.
Ann R Coll Surg Engl. 2019 Apr;101(4):235-248. doi: 10.1308/rcsann.2019.0011. Epub 2019 Mar 11.
Acute appendicitis is a common and serious situation during pregnancy, because of the increased risk of fetal loss and perforation in the third trimester, as well as a diagnostic difficulty. During recent years laparoscopic approach has been introduced to clinical practice with encouraging results. The purpose of this meta-analysis is to compare the surgical and obstetrical outcomes between laparoscopic and open appendectomy during pregnancy.
MEDLINE, SCOPUS, Clinicaltrials.gov, CENTRAL and Google Scholar were searched for studies reporting on postoperative outcomes between laparoscopic and open appendectomy during pregnancy. The random effects model (DerSimonian-Laird) was used to calculate pooled effect estimates when high heterogeneity was encountered, otherwise the fixed-effects (Mantel-Haenszel) model was implemented.
Twenty-one studies that enrolled 6276 pregnant women are included in the present meta-analysis. Of these women, 1963 underwent laparoscopic appendectomy and 4313 underwent an open appendectomy. Women who underwent laparoscopic appendectomy demonstrated an increase in fetal loss risk, while neonates of women that underwent open appendectomy presented decreased Apgar score at five minutes after birth. All the rest outcomes were similar between the two groups. The time that each study took place seemed to affect the comparison of birth weight and postoperative hospital stay between the two groups.
Laparoscopic appendectomy seems to be a relatively safe therapeutic option in pregnancy when it is indicated. Thus, it should be implemented in clinical practice, always considering the experience of the surgeon in such procedures. Nevertheless, the need of new studies to enhance this statement remains crucial.
急性阑尾炎是孕期常见且严重的情况，因为孕晚期胎儿丢失和穿孔风险增加，且存在诊断困难。近年来，腹腔镜手术已引入临床实践并取得了令人鼓舞的结果。本荟萃分析的目的是比较孕期腹腔镜阑尾切除术和开腹阑尾切除术的手术及产科结局。
检索了MEDLINE、SCOPUS、Clinicaltrials.gov、CENTRAL和谷歌学术，以查找关于孕期腹腔镜阑尾切除术和开腹阑尾切除术术后结局的研究报告。当遇到高度异质性时，使用随机效应模型（DerSimonian-Laird）计算合并效应估计值，否则采用固定效应（Mantel-Haenszel）模型。
本荟萃分析纳入了21项研究，共6276名孕妇。其中，1963名孕妇接受了腹腔镜阑尾切除术，4313名孕妇接受了开腹阑尾切除术。接受腹腔镜阑尾切除术的女性胎儿丢失风险增加，而接受开腹阑尾切除术的女性新生儿出生后5分钟的阿氏评分降低。两组的所有其他结局相似。每项研究进行的时间似乎影响两组出生体重和术后住院时间的比较。
当有指征时，腹腔镜阑尾切除术在孕期似乎是一种相对安全的治疗选择。因此，应在临床实践中实施，同时始终考虑外科医生在此类手术中的经验。然而，开展新的研究以强化这一观点仍然至关重要。
