Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, 606-8501, Japan.
World J Surg. 2021 Jun;45(6):1717-1724. doi: 10.1007/s00268-021-06010-w. Epub 2021 Feb 26.
We have described the epidemiology, diagnostic modality, treatment patterns, and outcomes of acute appendicitis during pregnancy.
Using a nationwide claim-based database in Japan, we analyzed the data of pregnant patients who were diagnosed with appendicitis between January 2005 and May 2019. Patient characteristics, imaging studies, length of hospital stay, proportion of fetal losses, complications, and type of antibiotics were examined.
The study included 169 patients, of whom 113 patients (67%) underwent conservative management, and appendectomies were performed on 56 patients (open 25% and laparoscopic 8%). The proportion of ultrasonography, computed tomography, and magnetic resonance imaging were 97%, 17%, and 5% (for conservative management); 88%, 39%, and 13% (for appendectomy); 86%, 38%, and 21% (for open appendectomy); and 93%, 43%, and 14% (for laparoscopic appendectomy), respectively. The proportion of complicated appendicitis was 6% in conservative management and 41% in appendectomy (40% in open appendectomy and 43% in laparoscopic appendectomy), respectively. The incidence of fetal loss was 4% in conservative management, 5% in appendectomy (2% in open appendectomy, and 14% in laparoscopic appendectomy). However, there was only one fetal loss (in laparoscopic appendectomy) in the same case of hospitalization. There were no maternal deaths or serious complications after any treatment.
All treatments showed acceptable outcomes in appendicitis during pregnancy. Conservative management is considered an acceptable option, especially in uncomplicated cases of appendicitis in pregnant women.
我们描述了妊娠期急性阑尾炎的流行病学、诊断方式、治疗模式和结局。
利用日本全国性的基于索赔的数据库，我们分析了 2005 年 1 月至 2019 年 5 月期间被诊断为阑尾炎的孕妇患者的数据。检查了患者特征、影像学研究、住院时间、胎儿丢失率、并发症和抗生素类型。
本研究纳入了 169 例患者，其中 113 例（67%）接受了保守治疗，56 例（25%行开腹手术，8%行腹腔镜手术）行阑尾切除术。超声、计算机断层扫描和磁共振成像的比例分别为 97%、17%和 5%（用于保守治疗）；88%、39%和 13%（用于阑尾切除术）；86%、38%和 21%（用于开腹阑尾切除术）；93%、43%和 14%（用于腹腔镜阑尾切除术）。保守治疗中复杂阑尾炎的比例为 6%，阑尾切除术中为 41%（开腹阑尾切除术中为 40%，腹腔镜阑尾切除术中为 43%）。保守治疗中胎儿丢失率为 4%，阑尾切除术中为 5%（开腹阑尾切除术中为 2%，腹腔镜阑尾切除术中为 14%）。然而，在同一次住院期间，只有 1 例（腹腔镜阑尾切除术）发生胎儿丢失。任何治疗后均无产妇死亡或严重并发症。
所有治疗方法在妊娠期阑尾炎中均显示出可接受的结局。保守治疗被认为是一种可接受的选择，尤其是在孕妇中不复杂的阑尾炎病例中。
