JAMA子刊:孕期突发阑尾炎,手术 or 不手术?
创作:Epi汪 审核:Epi汪 2022年04月22日
  • 纳入2003-2015年间诊断为复杂性阑尾炎的孕妇,其中55.5%立即接受手术,在保守治疗中有26.5%治愈,而有73.5%的孕妇保守治疗失败,继而再接受手术治疗;
  • 与立即手术相比,保守治疗成功的孕妇发生羊膜感染、败血症的风险分别增高4.35、1.52倍;
  • 而保守治疗失败的女性发生早产、流产的风险均增高;
  • 此外,立即手术的孕妇总的住院费用更低;
  • 亚组分析提示,随着手术时间的延迟,发生早产、流产的风险均有所增加。
主编推荐语
Epi汪
女性在妊娠期突发阑尾炎是否需要手术治疗一直存有争议。本研究基于真实世界的证据,分析发现保守治疗的成功率较低,且孕妇发生母体感染并发症风险增高。但是注意到,本研究关注的结局仅局限在短期,应进一步观察孕期阑尾炎手术治疗对母婴长远健康结局的影响。
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JAMA Network Open [IF:13.353]

Management of Complicated Appendicitis During Pregnancy in the US

美国妊娠期并发症阑尾炎的管理

10.1001/jamanetworkopen.2022.7555

2022-04-01, Article

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Importance : Data are sparse regarding the optimal treatment for complicated appendicitis during pregnancy.
Objective : To compare nonoperative and operative management in complicated appendicitis during pregnancy.
Design, Setting, and Participants: This cohort study was conducted using National Inpatient Sample data from between January 2003 and September 2015. This database approximates a 20% stratified sample of US inpatient hospital discharges. Included individuals were pregnant women discharged with the diagnosis of complicated appendicitis. Data were analyzed from February 2020 through February 2022.
Exposures : Study patients were categorized into 3 groups: those with successful nonoperative management, failed nonoperative management with delayed operation, or immediate operation for complicated appendicitis.
Main Outcomes and Measures : Clinical outcomes, including maternal infectious complications and perinatal complications, hospital length of stay, and total hospital charges.
Results : Among 8087 pregnant women with complicated appendicitis (median [IQR] age, 27 [22-32] years), nonoperative management of complicated appendicitis was successful among 954 patients (11.8%) and failed among 2646 patients (32.7%), who underwent delayed operation; 4487 patients (55.5%) underwent immediate operation. In multivariate analysis, successful nonoperative management was associated with higher odds of amniotic infection (odds ratio [OR], 4.35; 95% CI, 2.22-8.53; P < .001) and sepsis (OR, 1.52; 95% CI, 1.10-2.11; P = .01) compared with immediate operation, while there was no significant difference in preterm delivery, preterm labor, or abortion. However, failed nonoperative management that required delayed operation was associated with higher odds of preterm delivery, preterm labor, or abortion compared with immediate operation (OR, 1.45; 95% CI, 1.24-1.68; P < .001). Immediate operation was associated with decreased hospital charges compared with nonoperative management that was successful (regression coefficient [RC], 0.09; 95% CI, 0.07-0.11; P < .001) and that failed (RC, 0.12; 95% CI: 0.11-0.14; P < .001). In subgroup multivariate logistic regression analysis, each day in delay to surgery was associated with an increase in odds of preterm delivery, preterm labor, or abortion by 23% (OR, 1.23; 95% CI, 1.18-1.29; P < .001).
Conclusions and Relevance : This study found that immediate operation for complicated appendicitis in pregnant women was associated with lower odds of maternal infectious complications without higher odds of perinatal or other maternal complications compared with successful nonoperative management. Failed nonoperative management was associated with worse clinical outcomes.

First Authors:
Matthew Ashbrook

Correspondence Authors:
Kazuhide Matsushima

All Authors:
Matthew Ashbrook,Vincent Cheng,Kulmeet Sandhu,Koji Matsuo,Morgan Schellenberg,Kenji Inaba,Kazuhide Matsushima

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