Informative content of clinical symptoms of acute appendicitis in different terms of pregnancy

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ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɍȾɄ 616.346.2-002.1-036:618.231

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Ƚɍ «Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤɚɹ ɦɟɞɢɰɢɧɫɤɚɹ ɚɤɚɞɟɦɢɹ ɆɁ ɍɤɪɚɢɧɵ»

ɤɚɮɟɞɪɚ ɯɢɪɭɪɝɢɢ ʋ 2

(ɡɚɜ. – ɞ.ɦɟɞ.ɧ.,ɩɪɨɮ.Ⱥ.Ȼ.Ʉɭɬɨɜɨɣ)

ɭɥ.Ⱦɡɟɪɠɢɧɫɤɨɝɨ 9, Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤ, 49044, ɍɤɪɚɢɧɚ

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine» Surgery N 2 department

Dzerzhinsky str., 9, Dnipropetrovsk, 49044, Ukraine e-mail: innapetra@mail.ru

Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ:ɤɥɢɧɢɱɟɫɤɢɟ ɫɢɦɩɬɨɦɵ,ɨɫɬɪɵɣ ɚɩɩɟɧɞɢɰɢɬ,ɛɟɪɟɦɟɧɧɨɫɬɶ

Key words: clinical symptoms, acute appendicitis, pregnancy

Ɋɟɮɟɪɚɬ. ȱɧɮɨɪɦɚɬɢɜɧɿɫɬɶ ɤɥɿɧɿɱɧɢɯ ɫɢɦɩɬɨɦɿɜ ɝɨɫɬɪɨɝɨ ɚɩɟɧɞɢɰɢɬɭ ɜ ɪɿɡɧɿ ɬɟɪɦɿɧɢ ɜɚɝɿɬɧɨɫɬɿ.

Ʉɭɬɨɜɢɣ Ɉ.Ȼ., ɉɟɬɪɚɲɟɧɤɨ ȱ.ȱ. Ɂ ɦɟɬɨɸ ɨɰɿɧɤɢ ɞɿɚɝɧɨɫɬɢɱɧɨʀ ɟɮɟɤɬɢɜɧɨɫɬɿ ɧɢɡɤɢ ɤɥɿɧɿɱɧɢɯ ɫɢɦɩɬɨɦɿɜ ɝɨɫɬɪɨɝɨ ɚɩɟɧɞɢɰɢɬɭ ɛɭɥɨ ɨɛɫɬɟɠɟɧɨ 75 ɠɿɧɨɤ ɭ ɪɿɡɧɿ ɬɟɪɦɿɧɢ ɜɚɝɿɬɧɨɫɬɿ.ȼɢɜɱɟɧɚ ɿɧɮɨɪɦɚɬɢɜɧɿɫɬɶ ɬɚɤɢɯ

ɫɢɦɩɬɨɦɿɜ, ɹɤ Ʉɨɯɟɪɚ-ȼɨɥɤɨɜɢɱɚ, Ɋɨɜɡɿɧɝɚ, Ȼɚɪɬɨɦ'ɽ-Ɇɿɯɟɥɶɫɨɧɚ, ɋɿɬɤɨɜɫɶɤɨɝɨ, Ƚɚɛɚɹ, Ȼɪɟɧɞɨ, Ɇɿɯɟɥɶɫɨɧɚ,

ȱɜɚɧɨɜɚ.Ȼɨɥɶɨɜɢɣ ɫɢɧɞɪɨɦ ɛɭɜ ɡɚɮɿɤɫɨɜɚɧɢɣ ɭ ɜɫɿɯ ɨɛɫɬɟɠɟɧɢɯ ɠɿɧɨɤ.Ʌɨɤɚɥɿɡɚɰɿɹ ɛɨɥɸ ɛɭɥɚ ɪɿɡɧɨɦɚɧɿɬɧɨɸ ɿ

ɡɚɥɟɠɚɥɚ ɜɿɞ ɫɬɪɨɤɭ ɜɚɝɿɬɧɨɫɬɿ.Ɍɚɤ,ɜ ȱ ɬɪɢɦɟɫɬɪɿ ɜɚɝɿɬɧɨɫɬɿ ɛɿɥɶ ɱɚɫɬɿɲɟ ɩɪɨɹɜɥɹɜɫɹ ɜ ɟɩɿɝɚɫɬɪɚɥɶɧɿɣ ɬɚ

ɩɪɚɜɿɣ ɡɞɭɯɜɢɧɧɿɣ ɞɿɥɹɧɤɚɯ, ɪɿɞɲɟ ɜ ɿɧɲɢɯ ɜɿɞɞɿɥɚɯ ɱɟɪɟɜɚ. ȼ ȱȱ ɬɪɢɦɟɫɬɪɿ ɜ ɛɿɥɶɲɨɫɬɿ ɜɢɩɚɞɤɿɜ ɛɿɥɶ

ɫɩɨɫɬɟɪɿɝɚɜɫɹ ɜ ɩɪɚɜɿɣ ɡɞɭɯɜɢɧɧɿɣ ɞɿɥɹɧɰɿ.ɍ ȱȱȱ ɬɪɢɦɟɫɬɪɿ ɜɚɝɿɬɧɨɫɬɿ ɛɿɥɶ ɩɪɟɜɚɥɸɜɚɜ ɭ ɩɪɚɜɨɦɭ ɩɿɞɪɟɛɟɪ'ʀ.

Ⱥɧɚɥɿɡɭɸɱɢ ɿɧɮɨɪɦɚɬɢɜɧɿɫɬɶ ɞɨɫɥɿɞɠɭɜɚɧɢɯ ɫɢɦɩɬɨɦɿɜ,ɛɭɥɨ ɜɿɞɦɿɱɟɧɨ ɞɨɫɬɨɜɿɪɧɟ ɡɧɢɠɟɧɧɹ (ɪ<0,05; ɪ<0,01;

ɪ<0,001) ʀɯ ɞɿɚɝɧɨɫɬɢɱɧɨʀ ɟɮɟɤɬɢɜɧɨɫɬɿ ɡɿ ɡɛɿɥɶɲɟɧɧɹɦ ɫɬɪɨɤɭ ɝɟɫɬɚɰɿʀ.Ɉɬɠɟ,ɧɚɣɛɿɥɶɲ ɿɧɮɨɪɦɚɬɢɜɧɢɦɢ ɜ ȱ

ɬɪɢɦɟɫɬɪɿ ɜɚɝɿɬɧɨɫɬɿ ɛɭɥɢ ɫɢɦɩɬɨɦɢ Ʉɨɯɟɪɚ-ȼɨɥɤɨɜɢɱɚ ɿ Ɋɨɜɡɿɧɝɚ. Ⱦɿɚɝɧɨɫɬɢɱɧɚ ɟɮɟɤɬɢɜɧɿɫɬɶ ɫɢɦɩɬɨɦɿɜ

Ȼɪɟɧɞɨ (67,3%), Ɇɿɯɟɥɶɫɨɧɚ (55,7%) ɣ ȱɜɚɧɨɜɚ (59,6%) ɛɭɥɚ ɜɢɳɨɸ,ɧɿɠ ɭ ɫɢɦɩɬɨɦɿɜ Ʉɨɯɟɪɚ-ȼɨɥɤɨɜɢɱɚ (36,5%),

Ɋɨɜɡɿɧɝɚ (28,8%), ɋɿɬɤɨɜɫɶɤɨɝɨ (51,9%), Ȼɚɪɬɨɦ'ɽ-Ɇɿɯɟɥɶɫɨɧɚ (55,7%), ɰɿɧɧɿɫɬɶ ɹɤɢɯ ɜɬɪɚɱɚɥɚɫɶ ɡɿ

ɡɛɿɥɶɲɟɧɧɹɦ ɬɟɪɦɿɧɿɜ ɜɚɝɿɬɧɨɫɬɿ.

Abstract. Informative content of clinical symptoms of acute appendicitis in different terms of pregnancy.

Kutovoy A.B., Petrashenko I.I. With the purpose to evaluate diagnostic efficacy of some clinical symptoms of acute

appendicitis 75 women in different terms of pregnancy were examined. Informative content of such symptoms as Kocher- Volkovich, Rovsing, Bartomje - Michelson, Sitkovsky, Gabay, Brendo, Michelson, Ivanov was studied. Pain syndrome was fixed in all examined women. Pain localization was various and depended on the pregnancy term. During the I trimester of pregnancy the most often pain was manifestated in epigastrium and right lower quadrant, rarely in other abdomen regions. In the II trimester in majority of cases pain occurred in right lower quadrant. During III trimester pain prevailed in right upper quadrant of abdomen. Analyzing informative component of researching symptoms there was noted significant decrease (ɪ<0,05; ɪ<0,01; ɪ<0,001) of their diagnostic value with growth of pregnancy term. Therefore Kocher – Volkovich and Rovsing symptoms were the most informative in the I trimester of pregnancy. Diagnostic efficacy of Brendo(67,3%), Michelson(55,7%), Ivanov(59,6%) symptoms was higher than that of Kocher – Volkovich (36,5%), Rovsing (28,8%), Sitkovsky (51,9%), Bartomje – Michelson (55,7%) symptoms, their value was diminishing together with increase of pregnancy terms.

ȼɨɩɪɨɫɵ ɞɢɚɝɧɨɫɬɢɤɢ ɨɫɬɪɨɣ ɯɢɪɭɪɝɢɱɟɫɤɨɣ ɚɛɞɨɦɢɧɚɥɶɧɨɣ ɩɚɬɨɥɨɝɢɢ ɭ ɛɟɪɟɦɟɧɧɵɯ ɹɜ -ɥɹɸɬɫɹ ɫɥɨɠɧɵɦɢ ɢ ɧɟ ɞɨ ɤɨɧɰɚ ɪɟɲɟɧɧɵɦɢ. ȼ ɨɛɳɟɣ ɫɨɜɨɤɭɩɧɨɫɬɢ ɡɚɛɨɥɟɜɚɧɢɣ, ɬɪɟɛɭɸɳɢɯ ɫɪɨɱɧɨɣ ɨɩɟɪɚɰɢɢ ɧɚ ɮɨɧɟ ɛɟɪɟɦɟɧɧɨɫɬɢ,ɨɫɬɪɵɣ ɚɩɩɟɧɞɢɰɢɬ, ɱɚɫɬɨɬɚ ɤɨɬɨɪɨɝɨ ɫɨɫɬɚɜɥɹɟɬ 0,03-5,2%, ɡɚɧɢɦɚɟɬ ɥɢɞɢɪɭɸɳɭɸ ɩɨɡɢɰɢɸ.ɗɬɚ ɩɚɬɨ -ɥɨɝɢɹ, ɜɜɢɞɭ ɫɬɚɛɢɥɶɧɨɝɨ ɭɪɨɜɧɹ ɥɟɬɚɥɶɧɨɫɬɢ, ɛɟɡ ɬɟɧɞɟɧɰɢɢ ɤ ɫɧɢɠɟɧɢɸ (0,1-0,5%), ɩɨ ɫɟɣ ɞɟɧɶ ɫɨɯɪɚɧɹɟɬ ɫɜɨɸ ɚɤɬɭɚɥɶɧɨɫɬɶ [1, 5]. Ⱦɢɚɝɧɨ -ɫɬɢɱɟɫɤɢɟ ɨɲɢɛɤɢ ɩɪɢ ɨɫɬɪɨɦ ɚɩɩɟɧɞɢɰɢɬɟ ɜɨ

ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɧɚɛɥɸɞɚɸɬɫɹ ɜ 11,9-44,0% ɫɥɭɱɚɟɜ,ɩɪɢɱɟɦ ɜ ɪɚɜɧɨɣ ɦɟɪɟ ɞɨɩɭɫɤɚɟɬɫɹ ɝɢɩɨ -ɢ ɝ-ɢɩɟɪɞ-ɢɚɝɧɨɫɬ-ɢɤɚ, ɱɚɫɬɨɬɚ ɤɨɬɨɪɵɯ ɫɨ -ɨɬɜɟɬɫɬɜɟɧɧɨ ɫɨɫɬɚɜɥɹɟɬ 25,0% ɢ 31,0% [3, 6]. ȼ ɫɜɹɡɢ ɫ ɧɟɬɢɩɢɱɧɨɫɬɶɸ ɤɥɢɧɢɱɟɫɤɨɣ ɤɚɪɬɢɧɵ ɨɫɬɪɨɝɨ ɚɩɩɟɧɞɢɰɢɬɚ ɧɚ ɮɨɧɟ ɛɟɪɟɦɟɧɧɨɫɬɢ, ɨɫɨɛɨɟ ɡɧɚɱɟɧɢɟ ɢɦɟɟɬ ɜ ɞɢɚɝɧɨɫɬɢɤɟ ɫɢɦɩɬɨ -ɦɚɬɢɤɚ ɡɚɛɨɥɟɜɚɧɢɹ [2, 4].

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ɆȺɌȿɊɂȺɅɕ ɂ ɆȿɌɈȾɕ ɂɋɋɅȿȾɈȼȺɇɂɃ ȼ ɩɟɪɢɨɞ ɫ 2012 ɩɨ 2015 ɝ. ɜ ɯɢɪɭɪɝɢɱɟɫɤɭɸ ɤɥɢɧɢɤɭ ɨɛɥɚɫɧɨɣ ɤɥɢɧɢɱɟɫɤɨɣ ɛɨɥɶɧɢɰɵ ɢɦ. ɂ.ɂ.Ɇɟɱɧɢɤɨɜɚ ɫ ɞɢɚɝɧɨɡɨɦ ɨɫɬɪɵɣ ɚɩɩɟɧɞɢɰɢɬ ɛɵɥɨ ɧɚɩɪɚɜɥɟɧɨ 108 ɛɟɪɟɦɟɧɧɵɯ. ɉɨɤɚɡɚɧɢɹ ɤ ɚɩɩɟɧɞɷɤɬɨɦɢɢ ɛɵɥɢ ɜɵɪɚɛɨɬɚɧɵ ɭ 75 (69,4%) ɩɚɰɢɟɧɬɨɤ. ȼɨɡɪɚɫɬ ɛɨɥɶɧɵɯ ɫɨɫɬɚɜɢɥ ɨɬ 18 ɞɨ 40ɥɟɬ, ɫɪɟɞɧɢɣ – 25,7±0,5 ɝɨɞɚ. ɋɪɨɤɢ ɛɟɪɟɦɟɧ -ɧɨɫɬɢ ɤɨɥɟɛɚɥɢɫɶ ɨɬ 4-5 ɞɨ 35-36 ɧɟɞɟɥɶ. ɉɪɢ ɷɬɨɦ,ɛɟɪɟɦɟɧɧɵɯ ɜ I ɬɪɢɦɟɫɬɪɟ ɛɵɥɨ 26 (34,7%), ɜɨ II – 34 (45,3%) ɢ ɜ III – 15 (20,0%).

Ⱦɥɹ ɞɢɚɝɧɨɫɬɢɤɢ ɨɫɬɪɨɝɨ ɚɩɩɟɧɞɢɰɢɬɚ ɢɫ -ɩɨɥɶɡɨɜɚɥɢ ɨɛɳɢɟ ɤɥɢɧɢɱɟɫɤɢɟ ɫɢɦɩɬɨɦɵ Ʉɨ -ɯɟɪɚ-ȼɨɥɤɨɜɢɱɚ, Ȼɚɪɬɨɦɶɟ-Ɇɢɯɟɥɶɫɨɧɚ, ɋɢɬɤɨɜ -ɫɤɨɝɨ, Ɋɨɜɡɢɧɝɚ, Ƚɚɛɚɹ, ɚ ɬɚɤɠɟ ɯɚɪɚɤɬɟɪɧɵɟ ɞɥɹ ɛɟɪɟɦɟɧɧɨɫɬɢ: ɫɢɦɩɬɨɦɵ Ȼɪɟɧɞɨ, Ɇɢɯɟɥɶɫɨɧɚ, ɂɜɚɧɨɜɚ. Ɋɟɡɭɥɶɬɚɬɵ ɤɥɢɧɢɱɟɫɤɨɣ ɞɢɚɝɧɨɫɬɢɤɢ ɜɟɪɢɮɢɰɢɪɨɜɚɥɢ ɩɪɢ ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɨɦ ɜɦɟ -ɲɚɬɟɥɶɫɬɜɟ.

ɂɧɮɨɪɦɚɬɢɜɧɨɫɬɶ ɛɵɥɚ ɢɡɭɱɟɧɚ ɩɨ ɫɥɟɞɭɸ -ɳɢɦ ɤɪɢɬɟɪɢɹɦ: ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶ, ɫɩɟɰɢɮɢɱ -ɧɨɫɬɶ, ɬɨɱɧɨɫɬɶ ɢ ɷɮɮɟɤɬɢɜɧɨɫɬɶ, ɤɨɬɨɪɵɟ ɪɚɫ -ɫɱɢɬɵɜɚɥɢ ɩɨ ɮɨɪɦɭɥɚɦ:

ɞɢɚɝɧɨɫɬɢɱɟɫɤɚɹ ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶ

Ⱦɑ =

)

(

a

c

a

×100%,

)

(

d

b

ɞɢɚɝɧɨɫɬɢɱɟɫɤɚɹ ɬɨɱɧɨɫɬɶ

ȾɌ =

)

(

)

(

c

b

a

d

a

×100%,

ɞɢɚɝɧɨɫɬɢɱɟɫɤɚɹ ɷɮɮɟɤɬɢɜɧɨɫɬɶ

Ⱦɗ =

2 )

(

Ⱦɑ

Ⱦɋ

×100%,

ɝɞɟ ɚ – ɢɫɬɢɧɧɨɩɨɥɨɠɢɬɟɥɶɧɵɣ ɪɟɡɭɥɶɬɚɬ, c – ɥɨɠɧɨɩɨɥɨɠɢɬɟɥɶɧɵɣ ɪɟɡɭɥɶɬɚɬ, b – ɥɨɠɧɨɨɬɪɢɰɚɬɟɥɶɧɵɣ ɪɟɡɭɥɶɬɚɬ, d – ɢɫɬɢɧɧɨɨɬɪɢɰɚɬɟɥɶɧɵɣ ɪɟɡɭɥɶɬɚɬ.

ɋɬɚɬɢɫɬɢɫɬɢɱɟɫɤɢɣ ɚɧɚɥɢɡ ɩɪɨɜɨɞɢɥɢ ɩɨ ɨɛɳɟɩɪɢɧɹɬɵɦ ɦɟɬɨɞɚɦ ɫ ɪɚɫɱɟɬɨɦ ɫɪɟɞɧɟɣ ɚɪɢɮɦɟɬɢɱɟɫɤɨɣ (M), ɫɬɚɧɞɚɪɬɧɨɣ ɨɲɢɛɤɢ ɫɪɟɞ -ɧɟɣ ɚɪɢɮɦɟɬɢɱɟɫɤɨɣ (m), ɤɪɢɬɟɪɢɹ ɋɬɶɸɞɟɧɬɚ. Ɂɚ ɡɧɚɱɢɦɵɣ ɛɪɚɥɢ ɭɪɨɜɟɧɶ ɞɨɫɬɨɜɟɪɧɨɫɬɢ p<0,05 [1].

ɊȿɁɍɅɖɌȺɌɕ ɂ ɂɏ ɈȻɋɍɀȾȿɇɂȿ

ɇɚɥɢɱɢɟ ɛɨɥɟɜɨɝɨ ɫɢɧɞɪɨɦɚ ɡɚɮɢɤɫɢɪɨɜɚɧɨ ɭ ɜɫɟɯ ɩɚɰɢɟɧɬɨɤ.Ʉɚɤ ɩɪɚɜɢɥɨ,ɛɨɥɶ ɧɨɫɢɥɚ ɩɨɫɬɨ -ɹɧɧɵɣ ɧɨɸɳɢɣ ɯɚɪɚɤɬɟɪ.Ⱦɚɧɧɵɟ ɨ ɥɨɤɚɥɢɡɚɰɢɢ ɛɨɥɢ ɩɪɟɞɫɬɚɜɥɟɧɵ ɜ ɬɚɛɥɢɰɟ 1.

Ɍ ɚ ɛ ɥ ɢ ɰ ɚ 1

Ʌɨɤɚɥɢɡɚɰɢɹ ɛɨɥɢ ɜ ɪɚɡɧɵɟ ɫɪɨɤɢ ɛɟɪɟɦɟɧɧɨɫɬɢ

, n (%)

Ɍɪɢɦɟɫɬɪɵ Ʌɨɤɚɥɢɡɚɰɢɹ ɛɨɥɢ

ȱ (n=26) ȱȱ (n=34) ȱȱȱ (n=15)

ɗɩɢɝɚɫɬɪɚɥɶɧɚɹ ɨɛɥɚɫɬɶ,ɜ ɬɨɦ ɱɢɫɥɟ ɫ

ɩɨɫɥɟɞɭɸɳɟɣ ɞɢɫɥɨɤɚɰɢɟɣ 20 (76,9) 18 (52,9) ɪ1-2*

6(40,0)

ɪ 1-3***

ɉɪɚɜɨɟ ɩɨɞɪɟɛɟɪɶɟ 1(3,8) 7 (20,5)

ɪ 1-2*

9 (60,0)

ɪ 2-3***

ɪ 1-3

ɉɪɚɜɚɹ ɩɨɞɜɡɞɨɲɧɚɹ ɨɛɥɚɫɬɶ 19 (73,0) 29 (85,2)

ɪ 1-2*

5(33,3)

ɪ 2-3*

ɪ 1-3***

ɉɭɩɨɱɧɚɹ ɨɛɥɚɫɬɶ 7 (26,9) 9 (26,4) 4 (26,6)

ɇɢɠɧɢɟ ɨɬɞɟɥɵ ɠɢɜɨɬɚ 5 (19,2) - -

Ȼɟɡ ɱɟɬɤɨɣ ɥɨɤɚɥɢɡɚɰɢɢ 2 (7,6) 3(8,8) -

(3)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ȼ ȱ ɬɪɢɦɟɫɬɪɟ ɛɟɪɟɦɟɧɧɨɫɬɢ ɛɨɥɶ ɱɚɳɟ ɜɫɟɝɨ ɥɨɤɚɥɢɡɨɜɚɥɚɫɶ ɜ ɩɪɚɜɨɣ ɩɨɞɜɡɞɨɲɧɨɣ ɨɛɥɚɫɬɢ ɢ ɷɩɢɝɚɫɬɪɢɢ. ɍ ɨɫɬɚɥɶɧɵɯ 15 (57,6%) ɛɨɥɶɧɵɯ ɨɬɦɟɱɚɥɚɫɶ ɜ ɞɪɭɝɢɯ ɨɬɞɟɥɚɯ ɠɢɜɨɬɚ. ȼɨ ȱȱ ɬɪɢ -ɦɟɫɬɪɟ ɛɟɪɟɦɟɧɧɨɫɬɢ ɧɚɢɛɨɥɟɟ ɱɚɫɬɨ (85,2%) ɛɨɥɶ ɩɪɨɹɜɥɹɥɚɫɶ ɜ ɩɪɚɜɨɣ ɩɨɞɜɡɞɨɲɧɨɣ ɨɛɥɚɫ -ɬɢ, ɪɟɠɟ ɜ ɷɩɢɝɚɫɬɪɢɢ ɢ ɞɪɭɝɢɯ ɨɬɞɟɥɚɯ. ɍ

ɛɟɪɟɦɟɧɧɵɯ ɜ ȱȱȱ ɬɪɢɦɟɫɬɪɟ ɜ ɩɪɟɜɚɥɢɪɭɸɳɟɦ ɛɨɥɶɲɢɧɫɬɜɟ ɫɥɭɱɚɟɜ (60,0%) ɛɨɥɶ ɧɚɛɥɸɞɚɥɚɫɶ ɜ ɩɪɚɜɨɦ ɩɨɞɪɟɛɟɪɶɟ.

Ɋɟɡɭɥɶɬɚɬɵ ɱɚɫɬɨɬɵ ɩɪɨɹɜɥɟɧɢɹ ɫɢɦɩɬɨɦɨɜ ɨɫɬɪɨɝɨ ɚɩɩɟɧɞɢɰɢɬɚ ɜ ɪɚɡɧɵɟ ɫɪɨɤɢ ɛɟɪɟɦɟɧ -ɧɨɫɬɢ ɩɪɟɞɫɬɚɜɥɟɧɵ ɜ ɬɚɛɥɢɰɟ 2.

Ɍ ɚ ɛ ɥ ɢ ɰ ɚ 2

ɑɚɫɬɨɬɚ ɩɪɨɹɜɥɟɧɢɹ ɫɢɦɩɬɨɦɨɜ ɨɫɬɪɨɝɨ ɚɩɩɟɧɞɢɰɢɬɚ ɭ ɛɟɪɟɦɟɧɧɵɯ

, n (%)

Ɍɪɢɦɟɫɬɪɵ ɋɢɦɩɬɨɦɵ

ȱ (n=26) ȱȱ (n=34) ȱȱȱ (n=15)

Ʉɨɯɟɪɚ-ȼɨɥɤɨɜɢɱɚ 18 (69,2) 15 (44,1)

ɪ1-2*

4 (26,6)

ɪ1-3***

Ɋɨɜɡɢɧɝɚ 11 (42,3) 10 (29,4) 2 (13,3)

ɪ2-3*

ɪ 1-3**

Ȼɚɪɬɨɦɶɟ-Ɇɢɯɟɥɶɫɨɧɚ 19 (73,1) 28 (82,3) 9 (60,0)

ɪ2-3*

ɋɢɬɤɨɜɫɤɨɝɨ 18 (69,2) 27 (79,4) 8 (53,3)

ɪ2-3*

Ƚɚɛɚɹ - - 2 (13,3)

Ȼɪɟɧɞɨ - 29 (85,3) 12 (80,0)

Ɇɢɯɟɥɶɫɨɧɚ 17 (65,4) 27 (79,4) 9 (60,0)

ɪ2-3*

ɂɜɚɧɨɜɚ 19 (73,1) 26 (76,5) 10 (66,7)

ɉ ɪ ɢ ɦ ɟ ɱ ɚ ɧ ɢ ɹ: * ɪ <0,05; ** ɪ <0,01; ɪ <0,001*** - ɞɨɫɬɨɜɟɪɧɨɫɬɶ ɨɬɥɢɱɢɣ ɦɟɠɞɭ ɩɨɤɚɡɚɬɟɥɹɦɢ ɜ ɪɚɡɧɵɯ ɬɪɢɦɟɫɬɪɚɯ.

ɉɪɨɜɟɞɟɧɧɵɟ ɢɫɫɥɟɞɨɜɚɧɢɹ ɜɵɹɜɢɥɢ, ɱɬɨ ɱɚɫɬɨɬɚ ɩɪɨɹɜɥɟɧɢɹ ɫɢɦɩɬɨɦɨɜ Ʉɨɯɟɪɚ-ȼɨɥɤɨ -ɜɢɱɚ ɢ Ɋɨɜɡɢɧɝɚ ɢɦɟɥɚ ɞɨɫɬɨɜɟɪɧɨɟ (ɪ<0,05)ɫɧɢ -ɠɟɧɢɟ ɫ ɭɜɟɥɢɱɟɧɢɟɦ ɫɪɨɤɚ ɝɟɫɬɚɰɢɢ. ɋɢɦɩɬɨɦɵ Ȼɚɪɬɨɦɶɟ-Ɇɢɯɟɥɶɫɨɧɚ ɢ ɋɢɬɤɨɜɫɤɨɝɨ ɧɚɢɛɨɥɟɟ ɱɚɫɬɨ ɜɵɹɜɥɹɥɢɫɶ ɜɨ ȱȱ ɬɪɢɦɟɫɬɪɟ, ɬɚɤ ɠɟ ɤɚɤ ɢ ɫɢɦɩɬɨɦɵ Ȼɪɟɧɞɨ,Ɇɢɯɟɥɶɫɨɧɚ ɢ ɂɜɚɧɨɜɚ.ɋɪɟɞɢ ɨɛɫɥɟɞɭɟɦɵɯ ɠɟɳɢɧ ɫɢɦɩɬɨɦ Ƚɚɛɚɹ ɨɩɪɟɞɟɥɹɥɫɹ ɥɢɲɶ ɭ 2 (2,7%) ɛɟɪɟɦɟɧɧɵɯ ɜ ȱȱȱ ɬɪɢɦɟɫɬɪɟ.

Ɉɛɪɚɳɚɟɬ ɧɚ ɫɟɛɹ ɜɧɢɦɚɧɢɟ ɫɬɚɬɢɫɬɢɱɟɫɤɢ ɞɨɫɬɨɜɟɪɧɨɟ (ɪ<0,05)ɫɧɢɠɟɧɢɟ ɱɚɫɬɨɬɵ ɜɵɹɜɥɹɟ -ɦɨɫɬɢ ɫɢɦɩɬɨɦɚ Ɇɢɯɟɥɶɫɨɧɚ ɜ ȱȱȱ ɬɪɢɦɟɫɬɪɟ ɩɨ ɫɪɚɜɧɟɧɢɸ ɫ ɪɟɡɭɥɶɬɚɬɚɦɢ ɜɨ ȱȱ ɬɪɢɦɟɫɬɪɟ ɛɟɪɟɦɟɧɧɨɫɬɢ.

ɋɢɦɩɬɨɦ ɨɬɪɚɠɟɧɧɵɯ ɛɨɥɟɣ - ɫɢɦɩɬɨɦ ɂɜɚ -ɧɨɜɚ, ɜɫɬɪɟɱɚɥɫɹ ɞɨɫɬɚɬɨɱɧɨ ɱɚɫɬɨ ɜɧɟ ɡɚɜɢ -ɫɢɦɨɫɬɢ ɨɬ ɫɪɨɤɚ ɝɟɫɬɚɰɢɢ ɢ ɧɚɛɥɸɞɚɥɫɹ ɭ 55 (73,3%) ɛɟɪɟɦɟɧɧɵɯ. ɉɪɢ ɷɬɨɦ, ɜ I ɬɪɢɦɟɫɬɪɟ

ɛɨɥɶ ɱɚɳɟ ɢɪɪɚɞɢɢɪɨɜɚɥɚ ɜ ɧɢɠɧɢɟ ɨɬɞɟɥɵ ɠɢ -ɜɨɬɚ, ɚ ɜ ɩɨɡɞɧɢɟ ɫɪɨɤɢ ɛɟɪɟɦɟɧɧɨɫɬɢ ɨɬɪɚɠɟɧ -ɧɵɟ ɛɨɥɢ ɱɚɳɟ ɜɫɬɪɟɱɚɥɢɫɶ ɜ ɩɪɚɜɨɦ ɩɨɞɪɟɛɟɪɶɟ ɢ ɩɭɩɨɱɧɨɣ ɨɛɥɚɫɬɢ.Ɉɛɪɚɳɚɟɬ ɧɚ ɫɟɛɹ ɜɧɢɦɚɧɢɟ ɩɪɟɨɛɥɚɞɚɧɢɟ ɫɢɦɩɬɨɦɨɜ Ȼɪɟɧɞɨ, Ɇɢɯɟɥɶɫɨɧɚ, ɂɜɚɧɨɜɚ ɜɨ II ɬɪɢɦɟɫɬɪɟ ɛɟɪɟɦɟɧɧɨɫɬɢ.

ɂɧɮɨɪɦɚɬɢɜɧɨɫɬɶ ɫɢɦɩɬɨɦɨɜ ɨɫɬɪɨɝɨ ɚɩɩɟɧ -ɞɢɰɢɬɚ ɭ ɛɟɪɟɦɟɧɧɵɯ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɫɪɨɤɨɜ ɝɟɫɬɚɰɢɢ ɦɟɧɹɥɚɫɶ ɩɨ-ɪɚɡɧɨɦɭ (ɬɚɛɥ. 3).

(4)

ɜ ɪɚɡɧɵɟ ɫɪɨɤɢ ɛɟɪɟɦɟɧɧɨɫɬɢ

, (%)

Ⱦɢɚɝɧɨɫɬɢɱɟɫɤɚɹ ɰɟɧɧɨɫɬɶ ɤɥɢɧɢɱɟɫɤɨɝɨ ɫɢɦɩɬɨɦɚ Ʉɥɢɧɢɱɟɫɤɢɟ ɫɢɦɩɬɨɦɵ Ɍɪɢɦɟɫɬɪ

ɱɭɜɫɬɜɢɬɟɥɶ

-ɧɨɫɬɶ ɫɩɟɰɢɮɢɱɧɨɫɬɶ ɬɨɱɧɨɫɬɶ ɞɢɚɝɧɨɫɬɢɱɟɷɮɮɟɤɬɢɜɧɨɫɬɶcɤɚɹ

ȱ (Ɋȱ-ȱȱ) 72,0 100,0 73,0 86,0

ȱȱ(Ɋȱȱ-ȱȱȱ) 43,7* 50,0*** 44,1* 46,8*

Ʉɨɯɟɪɚ-ȼɨɥɤɨɜɢɱɚ

ȱȱȱ(Ɋȱ-ȱȱȱ) 23,0*** 50,0*** 26,7*** 36,5***

ȱ (Ɋȱ-ȱȱ) 44,0 100,0 46,1 72,0

ȱȱ (Ɋȱȱ-ȱȱȱ) 28,1** 50,0*** 29,4** 39,0**

Ɋɨɜɡɢɧɝɚ

ȱȱȱ (Ɋȱ-ȱȱȱ) 7,7*** 50,0*** 13,3*** 28,8***

ȱ (Ɋȱ-ȱȱ) 76,0 100,0 76,9 88,5**

ȱȱ (Ɋȱȱ-ȱȱȱ) 84,3* 50,0*** 82,3* 62,1

Ȼɚɪɬɨɦɶɟ-Ɇɢɯɟɥɶɫɨɧɚ

ȱȱȱ (Ɋȱ-ȱȱȱ) 61,5 50,0*** 60,0 55,7**

ȱ (Ɋȱ-ȱȱ) 72,0 100,0 73,1 86,0*

ȱȱ (Ɋȱȱ-ȱȱȱ) 82,1** 50,0*** 79,4* 65,6

ɋɢɬɤɨɜɫɤɨɝɨ

ȱȱȱ (Ɋȱ-ȱȱȱ) 53,8 50,0*** 53,3* 51,9**

ȱ - - - -

ȱȱ - - - -

Ƚɚɛɚɹ

ȱȱȱ 15,3 50,0 13,3 28,9

ȱ - - - -

ȱȱ 87,5 50,0 85,3 68,7

Ȼɪɟɧɞɨ

ȱȱȱ 84,6 50,0 80,0 67,3

ȱ (Ɋȱ-ȱȱȱ) 68,0 100,0 69,2 84,0*

ȱȱ (Ɋȱȱ-ȱȱȱ) 81,2* 50,0*** 79,4* 65,6

Ɇɢɯɟɥɶɫɨɧɚ

ȱȱȱ (Ɋȱ-ȱȱȱ) 61,5 50,0*** 60,7 55,7**

ȱ (Ɋȱ-ȱȱȱ) 76,0 100,0 76,9 88,0**

ȱȱ (Ɋȱȱ-ȱȱȱ) 78,1 50,0*** 76,5 64,0

ɂɜɚɧɨɜɚ

ȱȱȱ (Ɋȱ-ȱȱȱ) 69,2 50,0*** 66,7 59,6**

ɉ ɪ ɢ ɦ ɟ ɱ ɚ ɧ ɢ ɟ. * ɪ <0,05,** ɪ <0,01, ɪ <0,001*** - ɞɨɫɬɨɜɟɪɧɨɫɬɶ ɨɬɥɢɱɢɣ ɦɟɠɞɭ ɩɨɤɚɡɚɡɚɬɟɥɹɦɢ ɜ ɪɚɡɧɵɯ ɬɪɢɦɟɫɬɪɚɯ.

ɋɢɦɩɬɨɦ Ȼɪɟɧɞɨ ɧɟ ɨɩɪɟɞɟɥɹɥɫɹ ɜ I ɬɪɢ -ɦɟɫɬɪɟ ɛɟɪɟɦɟɧɧɨɫɬɢ, ɚ ɜɨ II ɢ III ɬɪɢɦɟɫɬɪɚɯ ɢɦɟɥɚ ɦɟɫɬɨ ɬɟɧɞɟɧɰɢɹ ɤ ɫɧɢɠɟɧɢɸ ɟɝɨ ɞɢɚɝɧɨ -ɫɬɢɱɟɫɤɨɣ ɢɧɮɨɪɦɚɬɢɜɧɨɫɬɢ.

Ⱥɧɚɥɢɡ ɩɨɥɭɱɟɧɧɵɯ ɞɚɧɧɵɯ ɩɨɤɚɡɚɥ, ɱɬɨ ɩɪɢ ɛɟɪɟɦɟɧɧɨɫɬɢ, ɨɫɨɛɟɧɧɨ ɜɨ ɜɬɨɪɨɣ ɩɨɥɨɜɢɧɟ, ɤɥɢɧɢɱɟɫɤɚɹ ɤɚɪɬɢɧɚ ɨɫɬɪɨɝɨ ɚɩɩɟɧɞɢɰɢɬɚ ɱɚɫɬɨ ɛɵɥɚ ɡɚɜɭɚɥɢɪɨɜɚɧɧɨɣ. Ɍɢɩɢɱɧɵɟ ɫɢɦɩɬɨɦɵ ɡɚɛɨɥɟɜɚɧɢɹ ɩɪɢ ɷɬɨɦ ɜɵɹɜɥɹɥɢɫɶ ɪɟɠɟ ɢ ɧɟ ɬɚɤ ɨɬɱɟɬɥɢɜɨ, ɱɬɨ ɜɵɡɵɜɚɥɨ ɡɧɚɱɢɬɟɥɶɧɵɟ ɬɪɭɞ -ɧɨɫɬɢ ɜ ɞɢɚɝ-ɧɨɫɬɢɤɟ ɢ ɨɛɭɫɥɚɜɥɢɜɚɥɨ ɧɟɨɛɯɨ -ɞɢɦɨɫɬɶ ɛɨɥɟɟ ɱɚɫɬɨɝɨ ɢɫɩɨɥɶɡɨɜɚɧɢɹ ɞɨɩɨɥɧɢ -ɬɟɥɶɧɵɯ ɦɟɬɨɞɨɜ ɢɫɫɥɟɞɨɜɚɧɢɹ.

ȼɕȼɈȾɕ

1. Ɉɞɧɢɦ ɢɡ ɯɚɪɚɤɬɟɪɧɵɯ ɩɪɨɹɜɥɟɧɢɣ ɨɫɬɪɨɝɨ ɚɩɩɟɧɞɢɰɢɬɚ ɧɚ ɮɨɧɟ ɛɟɪɟɦɟɧɧɨɫɬɢ ɹɜɥɹɥɫɹ ɛɨɥɟɜɨɣ ɫɢɧɞɪɨɦ, ɯɚɪɚɤɬɟɪ ɩɪɨɹɜɥɟɧɢɹ ɤɨɬɨɪɨɝɨ ɦɟɧɹɥɫɹ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɫɪɨɤɨɜ ɝɟɫɬɚɰɢɢ.

(5)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

3. ɋɢɦɩɬɨɦɵ Ʉɨɯɟɪɚ-ȼɨɥɤɨɜɢɱɚ, Ɋɨɜɡɢɧɝɚ, Ȼɚɪɬɨɦɶɟ-Ɇɢɯɟɥɶɫɨɧɚ,ɋɢɬɤɨɜɫɤɨɝɨ ɬɟɪɹɥɢ ɫɜɨɸ ɞɢɚɝɧɨɫɬɢɱɟɫɤɭɸ ɷɮɮɟɤɬɢɜɧɨɫɬɶ ɤ ȱȱȱ ɬɪɢɦɟɫɬɪɭ

ɛɟɪɟɦɟɧɧɨɫɬɢ, ɭɫɬɭɩɚɹ ɬɚɤɢɦ ɫɢɦɩɬɨɦɚɦ, ɤɚɤ Ȼɪɟɧɞɨ (67,3%), Ɇɢɯɟɥɶɫɨɧɚ (55,7%) ɢ ɂɜɚɧɨɜɚ (59,6%).

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1. ɀɢɥɢɧɚ ɇ.Ɇ.ɉɪɢɦɟɧɟɧɢɹ ɦɟɬɨɞɨɜ ɨɛɪɚɛɨɬɤɢ ɞɚɧɧɵɯ ɜ ɦɟɞɢɰɢɧɫɤɢɯ ɢɫɫɥɟɞɨɜɚɧɢɹɯ: ɦɟɬɨɞ. ɪɟɤɨ-ɦɟɧɞɚɰɢɢ / ɇ.Ɇ. ɀɢɥɢɧɚ.-ɇɨɜɨɤɭɡɧɟɰɤ: ȽɈɍ ȾɉɈ «ɇȽɂɍȼ»Ɋɨɫɡɞɪɚɜɚ, 2007. – 44 ɫ.

2. Ɉɫɬɪɵɣ ɚɩɩɟɧɞɢɰɢɬ ɭ ɛɟɪɟɦɟɧɧɵɯ (ɧɚɭɱɧɵɣ ɨɛɡɨɪ) / ȼ.ȼ.ɏɚɰɤɨ,Ɏ.Ⱥ.Ƚɪɟɞɠɟɜ,Ⱥ.ȼ.ɉɚɪɯɨɜ [ɢ ɞɪ.] //ɍɤɪ.ɠɭɪɧɚɥ ɯɢɪɭɪɝɢɢ. – 2014. – ʋ 1. – ɋ. 154-157.

3. ɋɨɜɪɟɦɟɧɧɵɟ ɬɟɯɧɨɥɨɝɢɢ ɜ ɞɢɚɝɧɨɫɬɢɤɟ ɨɫ-ɬɪɨɝɨ ɚɩɩɟɧɞɢɰɢɬɚ ɩɪɢ ɛɟɪɟɦɟɧɧɨɫɬɢ / ɘ.Ƚ.ɒɚɩɤɢɧ, Ƚ.ȼ.Ʌɢɜɚɞɧɵɣ, Ⱦ.ȼ. Ɇɚɪɲɚɥɨɜ [ɢ ɞɪ.] / Ȼɸɥ. ɦɟɞ. ɢɧɬɟɪɧɟɬ-ɤɨɧɮɟɪɟɧɰɢɣ. – 2011. – Ɍ. 1, ʋ 2. – ɋ. 29-37. 4. Ɏɟɞɨɪɨɜ ɂ.ȼ. Ʌɚɩɚɪɨɫɤɨɩɢɱɟɫɤɚɹ ɯɢɪɭɪɝɢɹ ɢ ɟɟ ɩɨɫɥɟɞɫɬɜɢɹ ɧɚ ɮɨɧɟ ɛɟɪɟɦɟɧɧɨɫɬɢ / ɂ.ȼ.Ɏɟɞɨɪɨɜ, Ɇ.ɂ.Ɇɚɡɢɬɨɜɚ // ɗɧɞɨɫɤɨɩ. ɯɢɪɭɪɝɢɹ. — 2010. — Ɍ. 16, ʋ 5. — ɋ. 38-42.

5. ɏɚɫɚɧɨɜ Ⱥ.Ƚ. Ʉɥɢɧɢɤɨ-ɦɨɪɮɨɥɨɝɢɱɟɫɤɢɟ ɨɫɨ-ɛɟɧɧɨɫɬɢ ɨɫɬɪɨɝɨ ɚɩɩɟɧɞɢɰɢɬɚ ɭ ɛɟɪɟɦɟɧɧɵɯ / Ⱥ.Ƚ.ɏɚɫɚɧɨɜ,ɗ.ȼ.əɧɛɚɪɢɫɨɜɚ,Ɏ.Ɏ.Ȼɚɞɪɟɬɞɢɧɨɜɚ //

Ɇɟɞ. ɜɟɫɬɧɢɤ Ȼɚɲɤɨɪɬɨɫɬɚɧɚ. – 2014. – Ɍ. 9, ʋ 5. – ɋ. 55-58.

6. ɒɚɣɦɚɪɞɚɧɨɜ Ɋ.ɒ. Ɉɫɬɪɵɣ ɚɩɩɟɧɞɢɰɢɬ ɭ ɛɟɪɟɦɟɧɧɵɯ / Ɋ.ɒ ɒɚɣɦɚɪɞɚɧɨɜ,Ɋ.Ɏ.Ƚɭɦɚɪɨɜ // ɉɪɚ-ɤɬɢɱɟɫɤɚɹ ɦɟɞɢɰɢɧɚ. – 2011. – ʋ 6. – ɋ. 53-57.

7. Al-Mulhim A.S. Appendectomy during pregnan-cy in sickle cell disease pationts / A.S. Al-Mulhim // Sau-di J. Gastroenterol. – 2008. – Vol. 14, N 3. – P. 114-117.

8. Appendectomy in pregnancy: evaluation of risk of negative appendectomy / K. Ito, H. Ito, E. E. Wrang [et al.] // Am. J. Surg. – 2012. – Vol. 203, N 2. – P. 145-150.

9. Korndorffer J.R. Jr. SAGES guideline for lapa-roscopic appendectomy / J.R.Jr. Korndorffer, E. Fellinger, W. Reed // Surg. Endoscop. – 2010. – Vol. 24. – P. 757-761.

10. Niemann U. Differential diagnosis of right abdomi-nal pain / U. Niemann, K. Tabatabai, U. Jordan, A. Imdahl // MMW Fortschr Med. – 2009. – Vol. 151, N 10. – P. 38-41.

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1. Zhilina NM. [Applications of data of processing methods in medical research: methodological recom-mendations]. Novokuznetsk: GOU DPO «NGIUV» Roszdrava, 2007;44. Russian.

2. Khatsko VV, Gredjev FA, Parkhomenko AV. [Acu-te appendicitis in pregnant women (scientific review)]. Ukrainsky journal hirurgii.2014;1:154-157. Russian.

3. Shapkin YuG, Livadnyy GV, Marshalov DV. [Modern technology in the diagnosis of acute appendicitis in pregnancy]. Byulleten' meditsinskikh internet-kon-ferentsiy.2011;1(2):29-37. Russian.

4. Fedorov IV [Laparoscopic surgery and its out-comes during pregnancy]. Endoskopicheskaya hirurgiya. 2010;16;5:59-62. Russian.

5. Hasanov AG [Clinical morphological features of acute appendicitis at pregnant] .Ɇɟdicinsky vestnik Bash-kortostana.2014;9(5):55-58. Russian.

6. Shaimardanov RS, Gumarov [Acute appendicitis at pregnant]. Prakticheskaya medicina. 2011;6:53-57. Russian.

7. Al-Mulhim AS. Appendectomy during pregnancy in sickle cell disease pationts. Saudi / J. Gastroenterol. 2008;14(3):114-7.

8. Ito K, Ito H, Wrang EE. Appendectomy in preg-nancy: evaluation of risk of negative appendectomy.Am. J. Surg. 2012;203(2):145-50.

9. Korndorffer JRJr, Fellinger E, Reed W. SAGES guideline for laparoscopic appendectomy. Surg. Endosc. 2010;24:757-61.

10. Niemann U, Tabatabai K, Jordan U, Imdahl A. Differential diagnosis of right abdominal pain. MMW Fortschr Med. 2009;151(10):38-41.