医学毕业论文--妊娠合并急性阑尾炎24例临床特点及诊治分析.doc

妊娠合并急性阑尾炎24例临床特点及诊治分析 【摘要】 　　目的：探讨妊娠合并急性阑尾炎的临床特点及其诊断与治疗。方法:我院2005年1月～2009年6月收治妊娠合并急性阑尾炎患者24例，所有患者均出现腹痛症状，外周血白细胞计数均＞10×109/L，20例采用阑尾切除术治疗，4例采用保守治疗，观察其治疗效果及病理情况。结果:20例手术患者均手术成功，其中6例阑尾切除术前行剖宫产术，术后无流产、切口感染及产妇死亡情况。4例保守治疗患者中3例治疗无效改行手术治疗，1例保守治疗患者症状缓解，无流产、早产。术后病理诊断，5例急性单纯性阑尾炎，10例急性化脓性阑尾炎，3例慢性阑尾炎急性发作，3例坏疽性阑尾炎，2例阑尾穿孔。结论:对于妊娠合并急性阑尾炎患者，准确诊断和及时治疗是关键。 【关键词】 妊娠；急性阑尾炎；妊娠并发症 ［ABSTRACT］ Objective: To discuss the clinic feature, diagnosis and treatment of pregnancy complicated with acute appendicitis.Methods: Selected 24 pregnancy cases complicated with acute appendicitis admitted from January 2005June 2009. All patients had abdominal pain, and peripheral blood leucocyte gt;10×109/L. Twenty cases had appendectomy, and 4 had conservative treatment. Observed the effect and pathological status.Results: Twenty cases had successful surgery incluing six cases with cesarean section before appendectomy, in which no abortion, incision infection or death occurred. Three cases with conservative treatment turned to surgery, and the other one was in relief, in which no abortion and early delivery occurred. The postoperative pathological diagnosis showed 5 cases with simple acute appendicitis, 10 cases with acute suppurative appendicitis, 3 chronic appendicitis cases with acute attach, 3 gangrenous appendicitis cases and 2 cases with appendiceal perforation.Conclusion: The diagnosis and treatment in time are the key for pregnancy with complication of acute appendicitis. ［KEY WORDS］ Pregnancy; Acute appendicitis; Pregnancy complication 急性阑尾炎是妊娠期最常见的外科疾病，发病率与非妊娠期相同，国内资料为0.5‰～1‰。妊娠各期均可发生急性阑尾炎，但在妊娠前6个月，分娩期及产褥期少见。妊娠合并急性阑尾炎临床表现不典型，增加诊断难度，使孕妇和胎儿的并发症和死亡率大大提高［1,2］。现对我院24例妊娠合并急性阑尾炎患者的临床特征及诊治情况进行回顾性分析并报道如下。 　　1 资料与方法 　　1.1 临床资料 2005年1月～2009年6月我院共收治妊娠合并急性阑尾炎患者24例，年龄21～38岁，平均25.9岁，其中初产妇17例，经产妇7例；孕早期6例，中期14例，晚期4例。病程2h～4d，平均1.8d。 　　1.2 临床表现 　　24例患者均出现腹痛症状，其中转移性右下腹痛8例，右侧腹痛9例，右肋下腹痛4例，全腹痛3例。右下腹麦氏点或稍高处压痛13例，反跳痛8例，肌紧张8例。恶心、呕吐6例，腹泻4例，便秘2例。体温正常或轻度升高（通常lt;38℃）18例，明显升高（gt;39℃）6例。外周血白细胞计数均gt;10×109/L，其中gt;15×109/L19