Akbas Ahmet, Aydın Kasap Zeliha, Hacım Nadir Adnan, Tokocin Merve, Altınel Yüksel, Yiğitbaş Hakan, Meriç Serhat, Okumuş Bakiye
Department of General Surgery, University of Health Sciences, Bağcılar Training and Research Hospital, İstanbul-Turkey.
Department Biostatistics and Medical Informatics, Karadeniz Technical University Faculty of Medicine, Trabzon-Turkey.
Ulus Travma Acil Cerrahi Derg. 2020 Sep;26(5):769-776. doi: 10.14744/tjtes.2020.03456.
Acute appendicitis (AA) is the most common extra-obstetric condition requiring surgery during pregnancy. AA diagnosis is made by laboratory tests along with anamnesis and physical examination findings. Due to the physiological and anatomical changes during the pregnancy, AA diagnosis is more challenging in pregnant women compared to non-pregnant patients. The present study evaluated the significance of white blood cell counts (WBC), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR) and lymphocyte-to-C-reactive protein ratio (LCR) to diagnose acute appendicitis during pregnancy.
Pregnant patients admitted to General Surgery Inpatient Clinic with AA pre-diagnosis in September 2015-December 2019 period were screened using International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10) diagnosis code (K35= acute appendicitis, Z33= pregnancy), and AA patients were identified retrospectively. The patients were divided into two groups. The Group I included the patients who had appendectomy due to AA and had a suppurative appendicitis diagnosis based on the pathological evaluation. On the other hand, Group II had the patients admitted as an inpatient with AA pre-diagnosis, but discharged from the hospital with full recovery without operation. Group III, i.e., the control group, on the other hand, was constituted by 32 randomly and prospectively recruited healthy pregnant women who were willing to participate in the study and who had matching study criteria among the patients followed in Obstetrics and Gynecology outpatient clinic of our hospital.
This study included 96 pregnant women with an average age of 29.20±4.47 years (32 healthy pregnant women, 32 pregnant women followed for acute abdominal observation and 32 pregnant women who underwent appendectomy). Of these patients, three cases who turned out not to have suppurative appendicitis (negative appendectomy) and two cases found to have perforated appendicitis based on intraoperative and histopathological evaluations were excluded from this study. The results showed that Group I patients had significantly higher WBC (p=0.001), CAR (p=0.001) and NLR (p=0.001), but significantly lower LCR values (p=0.001) compared to the Groups II and III. Besides, based on logistic regression analysis, it was revealed that higher WBC, CAR and NLR values and lower LCR values were independent variables that could be used for the diagnosis of AA in pregnant women.
Considering WBC, NLR, CAR and LCR parameters in addition to medical history, physical examination and imaging techniques could help clinicians diagnose acute appendicitis in pregnant women.
急性阑尾炎（AA）是孕期最常见的需要手术治疗的非产科疾病。AA的诊断通过实验室检查以及病史和体格检查结果来做出。由于孕期生理和解剖结构的变化，与非孕期患者相比，AA在孕妇中的诊断更具挑战性。本研究评估了白细胞计数（WBC）、中性粒细胞与淋巴细胞比值（NLR）、C反应蛋白/白蛋白比值（CAR）和淋巴细胞与C反应蛋白比值（LCR）在诊断孕期急性阑尾炎中的意义。
对2015年9月至2019年12月期间因预诊断为AA而入住普通外科住院病房的孕妇，使用国际疾病分类及相关健康问题统计分类第10版（ICD - 10）诊断编码（K35 = 急性阑尾炎，Z33 = 妊娠）进行筛查，并回顾性确定AA患者。患者分为两组。第一组包括因AA接受阑尾切除术且根据病理评估诊断为化脓性阑尾炎的患者。另一方面，第二组患者预诊断为AA住院，但未手术完全康复出院。第三组即对照组，由32名随机且前瞻性招募的健康孕妇组成，她们愿意参与研究且符合我院妇产科门诊随访患者的匹配研究标准。
本研究纳入96名平均年龄为29.20±4.47岁的孕妇（32名健康孕妇、32名因急性腹痛接受观察的孕妇和32名接受阑尾切除术的孕妇）。这些患者中，3例术中及组织病理学评估显示并非化脓性阑尾炎（阑尾切除术阴性）和2例发现有阑尾穿孔的患者被排除在本研究之外。结果显示，与第二组和第三组相比，第一组患者的WBC（p = 0.001）、CAR（p = 0.001）和NLR（p = 0.001）显著更高，但LCR值显著更低（p = 0.001）。此外，基于逻辑回归分析，结果显示较高的WBC、CAR和NLR值以及较低的LCR值是可用于诊断孕妇AA的独立变量。
除病史、体格检查和影像学技术外，考虑WBC、NLR、CAR和LCR参数有助于临床医生诊断孕妇急性阑尾炎。
