背景:当孕妇出现非产科病理时,照顾他们的医生可能不确定最佳管理策略。本指南的目的是为患有常见手术病理(包括阑尾炎)的孕妇制定循证建议。胆道疾病,和炎症性肠病(IBD)。
方法:美国胃肠和内窥镜外科医师协会(SAGES)指南委员会召集了一个工作组来解决这些问题。该小组提出了五个关键问题,并完成了文献的系统回顾和荟萃分析。然后,专家小组开会,根据建议评估的等级形成基于证据的建议,发展,和评价方法。当现有证据被认为不充分时,就利用了专家意见。
结果:专家小组同意了十项关于阑尾炎管理的建议,胆道疾病,怀孕期间的IBD。
结论:有条件的建议支持阑尾切除术而不是非手术治疗阑尾炎,腹腔镜阑尾切除术优于开腹阑尾切除术,腹腔镜胆囊切除术优于胆道疾病和急性胆囊炎的非手术治疗。根据专家意见,该小组还建议在妊娠晚期手术或非手术治疗除急性胆囊炎以外的胆道疾病,内镜逆行胰胆管造影术而非胆总管探查术治疗有症状的胆总管结石,在妊娠和非妊娠IBD患者中应用相同的紧急手术干预标准,对需要紧急手术治疗IBD的妊娠患者采用开放而非微创的方法,并在具有IBD专业知识的中心以多学科的方式管理患有活动性IBD耀斑的孕妇。
BACKGROUND: When pregnant patients present with nonobstetric pathology, the physicians caring for them may be uncertain about the optimal management strategy. The aim of this
guideline is to develop evidence-based recommendations for pregnant patients presenting with common surgical pathologies including appendicitis, biliary disease, and inflammatory bowel disease (IBD).
METHODS: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)
Guidelines Committee convened a working group to address these issues. The group generated five key questions and completed a systematic review and meta-analysis of the literature. An expert panel then met to form evidence-based recommendations according to the Grading of Recommendations Assessment, Development, and Evaluation approach. Expert opinion was utilized when the available evidence was deemed insufficient.
RESULTS: The expert panel agreed on ten recommendations addressing the management of appendicitis, biliary disease, and IBD during pregnancy.
CONCLUSIONS: Conditional recommendations were made in favor of appendectomy over nonoperative treatment of appendicitis, laparoscopic appendectomy over open appendectomy, and laparoscopic cholecystectomy over nonoperative treatment of biliary disease and acute cholecystitis specifically. Based on expert opinion, the panel also suggested either operative or nonoperative treatment of biliary diseases other than acute cholecystitis in the third trimester, endoscopic retrograde cholangiopancreatography rather than common bile duct exploration for symptomatic choledocholithiasis, applying the same criteria for emergent surgical intervention in pregnant and non-pregnant IBD patients, utilizing an open rather than minimally invasive approach for pregnant patients requiring emergent surgical treatment of IBD, and managing pregnant patients with active IBD flares in a multidisciplinary fashion at centers with IBD expertise.