目的:i]评估妊娠期间炎症性肠病[IBD]手术后妊娠和后代的演变;以及ii]描述适应症,手术技术,以及剖腹产伴随手术的频率。
方法:包括1998年以后妊娠期间因IBD而手术的患者。参与的临床医生被要求检查他们的数据库以识别病例。关于患者人口统计学的数据,IBD特点,医疗,IBD活动,妊娠结局,手术,delivery,以及胎儿和产妇的结局,被记录下来。
结果:总而言之,纳入44例IBD患者,其中75%患有克罗恩病;18%的手术在妊娠早期进行,55%在第二位,27%在妊娠晚期。一名患者在手术过程中出现并发症,27%有术后并发症。没有病人死亡。交付,70%是通过剖腹产进行的。有40名新生儿还活着。有四次流产/死产[第一次,第二个是两个,和一个在妊娠晚期];两个发生在手术过程中,另外2例发生在手术后2周;14%的中期手术和64%的晚期手术最终同时进行剖腹产或阴道分娩。在40个新生儿中,61%的人早产,47%的人出生体重低;42%的新生儿需要住院治疗[25%的人在重症监护病房]。
结论:妊娠期IBD手术仍然是一个极其严重的情况。因此,手术管理应在多学科团队中进行,涉及胃肠病学家,结直肠外科医生,产科医生,和新生儿专家。
OBJECTIVE: i] To evaluate the evolution of pregnancies and offspring after inflammatory bowel disease [IBD] surgery during pregnancy; and ii] to describe the indications, the surgical techniques, and the frequency of caesarean section concomitant with surgery.
METHODS: Patients operated on due to IBD during pregnancy after 1998 were included. Participating clinicians were asked to review their databases to identify cases. Data on patients\' demographics, IBD characteristics, medical treatments, IBD activity, pregnancy outcomes, surgery, delivery, and foetal and maternal outcomes, were recorded.
RESULTS: In all, 44 IBD patients were included, of whom 75% had Crohn\'s disease; 18% of the surgeries were performed in the first trimester, 55% in the second, and 27% in the third trimester. One patient had complications during surgery, and 27% had postsurgical complications. No patient died. Of deliveries, 70% were carried out by caesarean section. There were 40 newborns alive. There were four miscarriages/stillbirths [one in the first, two in the second, and one in the third trimester]; two occurred during surgery, and another two occurred 2 weeks after surgery; 14% of the surgeries during the second trimester and 64% of those in the third trimester ended up with a simultaneous caesarean section or vaginal delivery. Of the 40 newborns, 61% were premature and 47% had low birth weight; 42% of newborns needed hospitalisation [25% in the intensive care unit].
CONCLUSIONS: IBD surgery during pregnancy remains an extremely serious situation. Therefore, surgical management should be performed in a multidisciplinary team, involving gastroenterologists, colorectal surgeons, obstetricians, and neonatal specialists.