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目的研究分析中晚期妊娠合并非产科急腹症患者手术时机的选择,并探讨手术方案对母婴的影响。方法选择2014年10月-2015年12月天津市西青医院收治的中晚期妊娠孕妇21例为研究对象,所有对象均合并非产科急腹症。回顾性分析患者完整临床资料,探讨分析手术时机的选择以及对母婴的影响,总结临床诊治经验。结果疾病分类:急性阑尾炎8例,占38.1%,附件肿块扭转6例,占28.6%,子宫肌瘤变性2例,占9.5%,卵巢囊肿破裂1例,占4.8%,急性胰腺炎1例,占4.8%,输尿管结石1例,占4.8%,急性胆囊炎1例,占4.8%,急性小肠扭转1例,占4.8%。手术时机:急性阑尾炎、卵巢囊肿破裂、急性小肠扭转、附件肿块扭转、附件肿块扭转以及急性胆囊炎均在入院后6 h内行急诊手术治疗,子宫肌瘤变性及输尿管结石在入院后24 h内手术治疗,急性胰腺炎入院后观察2~4 d后行手术治疗。术中同时行剖宫产8例,占38.1%,术后引产2例,占9.5%。余患者继续妊娠。结论中晚期妊娠合并的急腹症临床特征不典型,对于明确诊断者应及时给予手术治疗,术中根据患者具体情况行个体化处理,保障母婴安全。
Objective To study the selection of the timing of surgery for patients with non-obstetric acute abdomen in the second and third trimester of pregnancy and to explore the influence of the operative protocol on the mothers and infants. Methods Twenty-one pregnant women of middle-late pregnancy who were treated in Xiqing Hospital of Tianjin from October 2014 to December 2015 were selected as the study subjects. All subjects were not obstetric acute abdomen. Retrospective analysis of patients with complete clinical data to explore the analysis of the timing of surgery and the impact on the mother and child, summarize the clinical diagnosis and treatment experience. Results Classification of diseases: 8 cases were acute appendicitis, accounting for 38.1%; 6 cases (28.6%) were malignant appendages, 2 cases of uterine fibroids degeneration (9.5%), 1 case of ovarian cyst rupture (4.8%), 1 case of acute pancreatitis Accounting for 4.8%, 1 ureteral calculi, accounting for 4.8%, 1 case of acute cholecystitis, accounting for 4.8%, 1 case of acute intestinal ischemia, accounting for 4.8%. The timing of surgery: acute appendicitis, ovarian cyst rupture, acute small intestine torsion, attachment mass torsion, accessory mass torsion and acute cholecystitis were performed within 6 h after admission to emergency surgery, uterine fibroids degeneration and ureteral calculi within 24 h after admission surgery Treatment, acute pancreatitis after admission observed 2 ~ 4 days after surgery. Intraoperative cesarean section in 8 cases, accounting for 38.1%, 2 cases of postoperative induction of labor, accounting for 9.5%. The remaining patients continue to pregnancy. Conclusions The clinical features of acute abdomen complicated by middle and late pregnancy are not typical. Surgical treatment should be given in time for definite diagnosis. The patients should be treated individually according to the specific conditions during the operation to ensure the safety of mother and infant.