Оцінка ефективності відеолапароскопічної апендектомії у вагітних

Abstract

The purpose of the study is to assess the efficiency results of treatment of acute appendicitis in pregnant women by using laparoscopy at different periods of gestation on the basis of studying the effect of increased intra-abdominal pressure due to carbon dioxide pneumoperitoneum on the course of pregnancy, the state of the uterus and fetus, as well as improving the technique of performing the operation. Materials and methods. 73 pregnant women with acute appendicitis were examined. The average age of the surveyed was 25.9±0.7 years, ranged from 17 to 42 years. The gestation period ranged from 4-5 to 37-39 weeks. There were 26 (35.6%) pregnant women in the first trimester, 32 (43.8%) – in the second trimester, and 15 (20.5%) – in the third trimester. The intervention was performed using the Olympus OTV-SC endoscopic complex. Pneumoperitoneum with CO2 was created about 10-12 mm Hg. In all women, the parameters of body temperature and blood pressure were studied, and the postoperative restoration of the motor-evacuation function of the gastrointestinal tract was assessed. Laboratory research included the study of individual indicators of the leukocyte formula, changes in the hemostasis system and microbial contamination of tissues of trocar wounds. The results of the effect of increased intra-abdominal pressure during laparoscopy on the state of the fetus and uterus in the early postoperative period were assessed using the BMT-9141 (Germany) and FM-7 (England) fetal monitor in women with a gestational age of 32 - 39 weeks. Results and discussion. The study showed that laparoscopy is possible with good results in the treatment of acute appendicitis in pregnant women in the first, second and third trimesters but with few exceptions. The technical features of performing laparoscopy in pregnant women are associated with the increased size of the uterus during the development of pregnancy. When substantiating therapeutic measures for endoscopic interventions based on the study and assessment of signs of systemic inflammatory response syndrome like temperature reaction, individual indicators of leukocyte count, peripheral hemodynamics, as well as restoration of dysfunctions of the gastrointestinal tract, the revealed advantages of laparoscopic appendectomy. Removal of the appendix from the abdominal cavity in plastic containers reduced microbial contamination of wounds, leading to a decrease in the number of postoperative complications. Conclusion. Laparoscopic interventions are effective in acute appendicitis in pregnant women. They provide a mild intoxication syndrome, rapid physical rehabilitation of patients. Their advantages are the reduction of manifestations of uterus and fetal disorders, rapid postoperative recovery of gastrointestinal tract functions