Samet ŞAHİN, Eyüp Murat YILMAZ, Mahir KIRNAP, Ethem BİLGİÇ, Ahmet Ender DEMİRKIRAN

GEBELIKTE AKUT APANDISITLE İLIŞKILI PARAMETRELER

Amaç Akut apandisit, gebelerde obstetrik olmayan akut batının en sık nedenidir. Gebe hastalarda sempatomatolojinin akla ilk olarak obstetrik nedenleri getirmesi, fizyolojik lökositozun gebelik boyunca görülmesi ve görüntüleme yöntemlerindeki kısıtlılıklar tanıda kafa karışıklığına neden olmaktadır. Bu durum laboratuvar parametrelerinde ayrıntılı değerlendirme ihtiyacını kaçınılmaz kılmaktadır. Çalışmanın amacı nötrofil lenfosit oranı (NLR), trombosit lenfosit oranı (PLR), lenfopeni gibi laboratuvar parametrelerinin apandisit tanısı ile ilişkisini ve tanısal gücünü ortaya koymaktır. Gereç ve Yöntem Değerlendirmede Ocak 2017-Şubat 2021 tarihleri arasında gebelikte akut apandisit tanısı ile opere edilen 31 hasta değerlendirildi. Hastaların demografik verileri, laboratuvar sonuçları, ultrasonografi veya manyetik rezonans görüntüleme raporları ve intraoperatif bulguları değerlendirilerek korelasyon ve roc analizi yapıldı. Bulgular Eksplorasyonda apandisit saptanması ile nötrofil, lökositoz ve NLR artışı arasında anlamlı bir ilişki bulundu (sırasıyla p: 0,014, p: 0,015, p: 0,020). Yine lenfopeni varlığı, yüksek NLR ve artmış palet/lenfosit oranı (PLR) uzamış yatış ile ilişkili bulundu (sırasıyla, p:0,037, p:0,008, p:0,024). Roc analizi ayrıca lökositoz [AUC: 0,938 (%95 CI: 0-1,00, p:0,019)], nötrofil yüksekliği [AUC: 0,938 (%95 CI: 0-1,00, p:0,019)] ve NLR [AUC: 0,917 (0-1,00 p: 0,025)] anlamlı akut apandisit varlığını ortaya koyma gücüne sahip olduğu bulundu. Sonuç Gebelerde akut apandisit tanısında hemogram parametrelerinin ve görüntüleme yöntemlerinin etkin bir şekilde kullanılması önerilmektedir.

Anahtar Kelimeler:

gebelik, akut apandisit, appendektomi

PARAMETERS ASSOCIATED WITH ACUTE APPENDICITIS IN PREGNANCY

Objective Acute appendicitis is the most common cause of nonobstetric acute abdomen in pregnant women. The fact that sympathomatology brings to mind primarily obstetric causes in pregnant patients, physiological leukocytosis is observed throughout pregnancy, and limitations in imaging methods cause confusion in the diagnosis. This makes the need for detailed evaluation in laboratory parameters inevitable. The aim of the study is to reveal the relationship of laboratory parameters such as neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), lymphopenia with the diagnosis of appendicitis and its diagnostic power. Material and Method In the evaluation of 31 patients who were operated on with the diagnosis of acute appendicitis during pregnancy between January 2017 and February 2021 were evaluated. Correlation and roc analysis were performed by evaluating patients' demographic data, laboratory results, ultrasonography or magnetic resonance imaging reports and intraoperative findings. Results A significant correlation was found between detection of appendicitis in exploration and increased neutrophils, leukocytosis, and NLR (p: 0.014, p: 0.015, p: 0.020, respectively). Again, the presence of lymphopenia, high NLR and increased palletelet / lymphocyte ratio (PLR) were found to be associated with prolonged hospitalization (p:0.037, p:0.008, and p:0.024, respectively). Roc analysis also showed that leukocytosis [AUC: 0.938 (95%CI: 0-1.00, p:0.019)], neutrophil elevation [AUC: 0.938 (95%CI: 0-1.00, p:0.019)] and NLR [AUC: 0.917 (0-1.00 p: 0.025)] was found to have the power to reveal the presence of significant acute appendicitis. Conclusion It is recommended to use hemogram parameters and imaging methods effectively in the diagnosis of acute appendicitis in pregnants.

Keywords:

pregnancy, acute appendicitis, appendectomy,

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