摘要
目的 急性闌尾炎是懷孕婦女最常見的腹部急症之一。及早闌尾切除一直是被視爲首選的治療方式，然而懷孕婦女同時合併有婦產科的症狀，因此對於急性闌尾炎的診斷被認爲是比較困難。我們回顧本院接受闌尾切除手術的懷孕婦女來加以探討。 方法 從1993年10月到2008年7月一共有31位懷孕婦女經診斷是急性闌尾炎而在臺大醫院接受闌尾切除手術。我們回顧收集這些病人的臨床資料包括懷孕週數，表現症狀，白血球數，術前超音波，病理診斷及相關產科事件。 結果 31位懷孕婦女接受闌尾切除手術，經病理切片分析符合急性闌尾炎者有25位。我們把31位病人分成陽性闌尾炎切除組(n=25)及陰性闌尾炎切除組(n=6)。白血球數在陽性闌尾切除組較高(p=0.048)，右下腹疼痛在陰性闌尾切除組表現爲100%(p=0.004)，至於腹部超音波的敏感度是80%而專一性是75%。正確診斷率在不同的三月期(trimester)分別是88.9%，73.3%，85.7%，平均診斷率爲80.6%。有10位婦女出現產科事件，包括一位死產以及兩位人工流產。 結論 急性闌尾炎的正確診斷率在懷孕婦女是相當於一般人，理學檢查以及問診對於診斷仍然相當重要，及早闌尾切除可避免複雜的窘境，然而產科事件在陽性闌尾炎的病人的確比較多。
並列摘要
Purpose. Acute appendicitis is one of the most common non-obstetric emergencies during pregnancy and early appendectomy is the usual treatment of choice. Because accurate diagnosis in pregnant women is more challenging due to the combined obstetric symptoms, this study reviewed such cases. Methods. From October 1993 to July 2008,31 pregnant patients who underwent appendectomy for acute appendicitis at the National Taiwan University Hospital were identified. Data on their gestational age, symptoms, leukocyte count, abdominal sonography, pathologic diagnosis, and perioperative obstetric events were obtained through a retrospective chart review. Results. Of the 31 patients who underwent appendectomy, 25 had confirmed acute appendicitis by histopathology. The patients were divided into the negative appendectomy (NA) group (n=6) and the positive appendectomy (PA) group (n=25). The median leukocyte count was 14,970/mm^3 in the PA group and 11,695/mm^3 in the NA group (p=0.048). The symptom of right lower quadrant pain was 100% in the NA group (p=0.004). Abdominal sonography had 80% sensitivity and 75% specificity. Among the first, second and third trimesters, diagnostic accuracy was 88.9%, 73.3%, and 85.7%, respectively (average 80.6%). Ten patients were complicated by obstetric events, including fetal death (n=1) and artificial abortion (n=2). Obstetric events were more in the PA group. Conclusions. The diagnostic accuracy of acute appendicitis in pregnant women is comparable to that of the general population. Physical examination and history taking remain important. Early appendectomy prevents complicated conditions. There are more obstetric events in pregnant patients of true appendicitis.
延伸閱讀
- 李耀泰、陳福民、郭宗正（2010）。懷孕期間的闌尾炎。當代醫學，(442)，619-622。https://doi.org/10.29941/MT.201008.0016
- Liao, J. J., Wu, C. C., & Jan, Y. J. (2010). 懷孕婦女的急性闌尾炎之闌尾切除. Formosan Journal of Surgery, 43(6), 294-299. https://doi.org/10.29833/FJS.201012.0004
- Chu, J. S., Yang, K. C., Hsu, T. C., Kao, C. R., Chou, S. Y., & Shih, S. C. (1993). 妊娠期之消化道惡性腫瘤. 中華民國消化系醫學會雜誌, 10(1), 1-8. https://doi.org/10.6557/GJTa.199303_10(1).0001
- Chang, Y. T., Huang, Y. S., Chan, H. M., Huang, C. J., Hsieh, J. S., & Huang, T. J. (2006). 懷孕時期的腸阻塞. The Kaohsiung Journal of Medical Sciences, 22(1), 20-23. https://www.airitilibrary.com/Article/Detail?DocID=02575655-200601-22-1-20-23-a
- 顏兆熊（2007）。懷孕期間之急性腹痛。當代醫學，(406)，612-618。https://doi.org/10.29941/MT.200708.0005