腹腔镜与开腹阑尾切除术治疗妊娠阑尾炎：单中心经验及荟萃分析。

Laparoscopic versus open appendicectomy in pregnancy: experience from a single institution and meta-analysis.

机构信息

Department of General Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia.

Department of Obstetrics and Gynaecology, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia.

出版信息

ANZ J Surg. 2022 May;92(5):1071-1078. doi: 10.1111/ans.17672. Epub 2022 Apr 3.

DOI:10.1111/ans.17672

PMID:35373462

Abstract

BACKGROUND

Acute appendicitis remains an uncommon cause of non-obstetric abdominal pain during pregnancy, with surgery being the preferred management option. We examined our experience with the surgical management of appendicitis during pregnancy, particularly the risk of foetal loss during the 1st and 2nd trimester and performed a meta-analysis of the available literature.

METHODS

We performed a retrospective analysis of all patients who had an appendicectomy during pregnancy (January 2010 to December 2019) and a meta-analysis comparing foetal death in open appendicectomy versus laparoscopic appendicectomy during the 1st and 2nd trimester.

RESULTS

Seventy pregnant patients were included in our study (57 laparoscopic, 13 open). There were 4 foetal deaths during the study period (7%), all of which occurred after the laparoscopic approach (P-value = 0.578). Open appendicectomies were associated with an increased risk of pre-term delivery (P-value = 0.038). The meta-analysis of 9 studies, which included 311 patients, showed that there was no significant difference between OA and LA in foetal deaths during the 1st and 2nd trimesters (1st trimester foetal deaths: 9/143 laparoscopic versus 4/57 open, M-H risk difference-0.02, 95% CI, -0.14 to 0.10): 2nd trimester foetal deaths: 7/159 laparoscopic versus 2/154 Open, M-H risk difference 0.03, 95% CI, -0.02 to 0.09).

CONCLUSION

Our findings suggest there is no increased risk of foetal loss in pregnant patients undergoing a laparoscopic appendicectomy.

摘要

背景

急性阑尾炎在妊娠期间仍然是一种罕见的非产科腹痛原因，手术是首选的治疗方法。我们检查了我们在妊娠期间阑尾炎手术管理方面的经验，特别是在第一和第二孕期发生胎儿丢失的风险，并对现有文献进行了荟萃分析。

方法

我们对所有在妊娠期间接受阑尾切除术的患者（2010 年 1 月至 2019 年 12 月）进行了回顾性分析，并对第一和第二孕期开腹阑尾切除术与腹腔镜阑尾切除术之间的胎儿死亡进行了荟萃分析。

结果

我们的研究包括 70 名孕妇（57 例腹腔镜，13 例开腹）。在研究期间有 4 例胎儿死亡（7%），均发生在腹腔镜手术后（P 值=0.578）。开腹阑尾切除术与早产风险增加相关（P 值=0.038）。对 9 项研究的荟萃分析，包括 311 例患者，表明在第一和第二孕期开腹阑尾切除术和腹腔镜阑尾切除术之间胎儿死亡没有显著差异（第一孕期胎儿死亡：143 例腹腔镜手术中有 9 例，57 例开腹手术中有 4 例，M-H 风险差异-0.02，95%CI，-0.14 至 0.10）；第二孕期胎儿死亡：159 例腹腔镜手术中有 7 例，154 例开腹手术中有 2 例，M-H 风险差异 0.03，95%CI，-0.02 至 0.09）。