Аналіз ефективності відеолапароскопії при гострому апендициті у вагітних

Abstract

Diagnosis and treatment of acute surgical abdominal pathology in pregnant women is still complex and not fully resolved issue. The most frequent reason of urgent surgery in pregnant is acute appendicitis. This pathology remains an urgent problem nowadays. Still there is no consensus on the choice of appendectomy method depending on gestational term. The introduction of endoscopic surgery into widespread clinical practice significantly changed the views on the possibility of using it in pregnant women. But possibility of performing laparoscopy in pregnant women still causes some caution. Moreover, laparoscopic techniques at different stages of pregnancy are far from being improved. Material and methods. The study involved 73 pregnant women with acute appendicitis (group I) and 43 non-pregnant women (group II), who were hospitalized to the clinic. The informativeness of laparoscopic method was studied according to the following criteria: sensitivity (Se), specificity (Sp), accuracy (Ac) and efficiency (De). For each of these criteria was calculated a 95% confidence interval (CI). Results and discussion. Research did not reveal correlation of frequency direct and indirect laparoscopic signs from gestational terms. The frequency of these signs was almost the same in the groups of pregnant and non-pregnant women. The most difficult laparoscopic diagnosis was with catarrhal changes in the wall of appendix, since morphological changes in this form of inflammation extended only to the mucous and submucosal membranes, and macroscopic changes were minimal. Such symptom as the imposition of fibrin in catarrhal appendicitis was absent in all cases. The rest of the signs were observed in all women studied, while macroscopic changes in destructive forms of appendicitis, indicating inflammation, were frequent compared with catarrhal ones. Attention drawn to high parameters of informativeness diagnostic laparoscopy in pregnant women in the first trimester. This is due to the coincidence of clinical and histological diagnoses in this trimester. Considering the number of truly negative results of the study in the II and III trimesters of pregnancy, the indicators of informativeness of laparoscopy did not differ much from the gestational age. Conclusion. Thus, laparoscopy as a diagnostic method for acute appendicitis turned out to be quite informative in both pregnant and non-pregnant women: it allowed confirming or excluding diagnosis of acute appendicitis, it also accurately determined the localization of appendix, choosing correct treatment tactics and safely perform an adequate low-traumatic surgery