Department of Surgery, County Hospital Ryhov, 551 85, Jönköping, Sweden.
Department of Clinical and Experimental Medicine, Faculty of Medicine, Health Sciences Linköping University, Linköping, Sweden.
World J Surg. 2020 Aug;44(8):2601-2608. doi: 10.1007/s00268-020-05524-z.
Previous studies indicate a low incidence of appendicitis in third-trimester pregnancy, suggesting a protecting effect of pregnancy. This large population-based cohort study analyzes the association of appendicitis with pregnancy in more detail. The aim of the study was to investigate the incidence of appendicitis and negative appendectomy before, during and after pregnancy.
Cross-linking between two Swedish health registries provided data on appendectomy for all women in Sweden giving birth between 1973 and 2013. We analyzed the incidence rates (IR) of perforated and non-perforated appendicitis and negative appendectomy before, during and after pregnancy, and secular trends during the study period. Standardized incidence ratios (SIR) were estimated using age-, sex- and period-specific IR from the background population in Sweden.
Some 3,888,452 pregnancies resulted in birth during the study period. An appendectomy was registered for 27,575 women in the interval starting one year before and ending two years after pregnancy. The incidence of appendicitis varied substantially during and after pregnancy. SIR for perforated appendicitis was 0.47 (95% CI 0.38-0.59) in the third trimester, 3.89 (2.92-5.18) peripartum, 2.20 (1.89-2.55) in the puerperium and 1.27 (1.19-1.36) in the year postpartum. The pattern was similar for non-perforated appendicitis. Negative appendectomy decreased postpartum. Incidence rate of non-perforated appendicitis and negative appendectomy decreased for both pregnant and non-pregnant women during the study period.
The findings in this study suggest a protecting effect of pregnancy on the development of appendicitis, which is followed by a rebound effect after birth.
先前的研究表明，妊娠晚期阑尾炎的发病率较低，这表明妊娠具有保护作用。本大规模基于人群的队列研究更详细地分析了阑尾炎与妊娠的关系。本研究的目的是调查妊娠前、妊娠期间和妊娠后阑尾炎的发生率和阴性阑尾切除术。
通过两个瑞典健康登记处的交联，为瑞典所有在 1973 年至 2013 年间分娩的妇女提供了阑尾切除术的数据。我们分析了穿孔性和非穿孔性阑尾炎以及妊娠前、妊娠期间和妊娠后阴性阑尾切除术的发病率（IR），并研究了研究期间的时间趋势。使用来自瑞典背景人群的年龄、性别和时期特异性 IR 来估计标准化发病率比（SIR）。
研究期间有 3888452 例妊娠导致分娩。在妊娠前一年至妊娠后两年结束期间，有 27575 名妇女记录了阑尾切除术。怀孕期间和之后阑尾炎的发病率差异很大。穿孔性阑尾炎的 SIR 在妊娠晚期为 0.47（95%CI 0.38-0.59），围产期为 3.89（2.92-5.18），产褥期为 2.20（1.89-2.55），产后一年为 1.27（1.19-1.36）。非穿孔性阑尾炎的情况类似。产后阴性阑尾切除术减少。在研究期间，无论是孕妇还是非孕妇，非穿孔性阑尾炎和阴性阑尾切除术的发病率都有所下降。
本研究的结果表明，妊娠对阑尾炎的发生有保护作用，分娩后会出现反弹效应。
