Apandisit ile Komplike Gebeliklerin Cerrahi Tedavisi ve Gebelik Sonuçları: Obstetrisyen Görüşü

Year 2015, Volume: 16 Issue: 2, 43 - 49, 01.08.2015

Deniz Şimşek Özgür Deniz Turan Ahmet Mete Ergenoğlu Halit Batuhan Demir Taylan Özgür Sezer Çağdaş Şahin

Abstract

Amaç: Gebeliğinde apendektomi yapılan hastaların gebelik sonuçlarının değerlendirilmesi.Gereç ve Yöntemler: 2010-2014 yılları arasında apendektomi yapılan hastalar retrospektif olarak incelendi. Tüm hastaların gebelik sonuçları üniversite kayıt sistemi ve telefon görüşmeleri ile takip edildi. Hastalar yaş, gebelik yaşı, klinik ve laboratuvar muayeneleri, görüntüleme çalışmaları,
acil servis ve operasyon arasındaki ortalama zaman, ortalama operasyon süresi, gebelik sonucu ve apandiksin patoloji sonucuna göre
değerlendirildi.
Bulgular: Otuz dokuz hasta çalışmaya dahil edildi. Otuz dokuz hastanın 16’sı ilk, 15’i ikinci ve 8’i gebeliğin üçüncü trimesterindeydi.
Üç hastaya laparoskopik apendektomi kalanlarına laparatomi yapıldı. Apendiksin patolojik değerlendirilmesinde, yedi hasta (17%)
normal apendiks, dört hasta perfore apendiks, bir hasta nöro-endokrin tümor ve kalanları apandisit saptandı. Operasyon sonrası iki
missed abortus meydana gelirken kalanları canlı doğum yaptı. Bunlardan altısı preterm ve otuz biri term doğum yaptı. On iki hasta
vajinal yolla ve kalanları sezaryen yoluyla doğurtuldu. Yirmi hasta gebeliğin birinci yarısında (grup 1) ve 19 hasta gebeliğin ikinci
yarısındaydı (grup 2). Gruplar arasında operasyon zamanı ve acile kabul ile operasyon arasındaki ortalama zaman aralığı açısıdan
anlamlı farklılık yoktu.
Sonuç: Gecikmiş operasyon ve negatif apendektomi olumsuz gebelik sonuçlarına neden olabilir. Şüpheli olgulardaki izlem tedavisi
negatif apendektomi oranlarını düşürebilir; ancak aynı zamanda perforasyona neden olabilir. Bilgisayarlı tomografi ve manyetik
rezonans görüntüleme, ultrasonografinin net olmadığı zaman düşünülmelidir. Erken doğum tehditini önlemek için tokolitik rejimler
uygulanabilir. Doğum şekli için obstetrik endikasyonlar geçerlidir.

Keywords

Apandisit, gebelik, cerrahi tedavi

Pregnancy Outcomes and Surgical Management of Pregnancy Complicated By Appendicitis: Obstetrician View

Abstract

Objective: To evaluate the pregnancy outcomes of patients who underwent appendectomy during pregnancy. Materials and Methods: Patients who underwent appendectomy between years 2010 and 2014 were retrospectively evaluated. All patients’ pregnancy outcomes were followed-up by using university registry system and telephone interview. Patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, mean time interval between emergency department and operation, mean operative time, pregnancy outcome and pathologic results of the appendix. Results: Thirty-nine patients were included in the study. Sixteen of 39 patients were in the first, 15 of them in the second and 8 of them were in the third trimester of the pregnancy. Three patients underwent laparoscopic appendectomy and the rest underwent laparotomy. In pathologic evaluation of the appendix, seven patients (17%) had normal appendix, 4 patients had perforated appendix, one patient had neuro-endocrine tumor and rest of the patients had appendicitis. Two missed abortion occurred after operation, rest of the patients had live birth. Six of them were preterm and 31 had term birth. Twelve patients delivered through vaginal birth and the rest via caesarean section. Twenty patients were in the first half of the pregnancy (group 1) and 19 patients were in the second half of the pregnancy (group 2). There were no significant differences between the groups in operation time and mean time interval between emergency administration and operation. Conclusion: Delayed operation and negative appendectomy can cause adverse pregnancy outcomes. Expectant management in suspected cases may decrease negative appendectomy rates but can also lead to perforation. Computed tomography and MRI ought to be considered if ultrasonography is inconclusive. Tocolytic regimens can be administered to prevent threatened preterm labor. Obstetric indications were valid for delivery mode.

Keywords

Appendicitis, pregnancy, surgical management

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