Ulus Travma Acil Cerrahi Derg. 2018; 24(4): 333-336 | DOI: 10.5505/tjtes.2017.23693

Gebeliðin evresine göre ultrasonografi ve laboratuvar testlerin akut apandisit tanýsýna etkisi

Adil Baþkýran¹, Volkan Ýnce¹, Egemen Çiçek¹, Tolga Þahin¹, Abuzer Dirican¹, Ýpek Balýkçý Çiçek², Burak Iþýk¹, Sezai Yýlmaz^1
1Ýnönü Üniversitesi Turgut Özal Týp Merkezi, Karaciðer Nakil Enstitüsü, Malatya
²Ýnönü Üniversitesi Týp Fakültesi, Biyoistatistik Anabilim Dalý, Malatya

AMAÇ: Gebelik sürecinde olan fizyolojik deðiþiklikler akut apandisit semptom bulgular ile benzerlik gösterdiði için tanýyý zorlaþtýrmaktadýr. Bu sebeple gebelik süresince tanýya yardýmcý olabilecek özgün radyolojik ve laboratuvar testleri yoktur. Bu çalýþmada amacýmýz gebelik trimesterlerine göre laboratuvar ve radyolojik testlerin hangi evrede daha etkili olduðunu araþtýrmaktýr.
GEREÇ VE YÖNTEM: 2012–2017 yýllarý arasýnda kliniðimizde ameliyat edilen ve patoloji raporlarýyla onaylý akut apandisit tanýsý alan gebe hastalarýn laboratuvar verilerinden nötrofil lenfosit oraný (NLO), platelet lenfosit oraný (PLO) analiz edilerek gebeliðin hangi evrelerinde daha anlamlý olduðu araþtýrýldý.
BULGULAR: Ortalama yaþ 25 (19–38) yýl. Ortalama gebelik haftasý 17 (6–31) ortalama lenfosit sayýsý 12.4 (6.3–22.4) hücre/m3 ultrasonografi %60 hastada apandisit ile uyumlu bulgular saptandý. Lenfosit sayýlarý, C-reaktif protein deðerleri, nötrofil sayýlarý ve ultrasonografi deðerleri açýsýndan 1. tirmester (grup 1) ve 2 ve 3 üncü trimester (grup 2) hastalar arasýnda anlamlý bir fark saptanmadý (p>0.05). Lenfosit sayýsý grup 2’de belirgin düþük izlendi (p>0.05). Nötrofil lenfosit oraný ve PLO oranlarý grup 2’de belirgin yüksek izlendi (p<0.05).
TARTIÞMA: Gebelik süresince önemli laboratuvar deðiþiklikleri olmaktadýr. Nötrofil lenfosit oraný ve PLO akut apandisit deðerlendirmesinde ve gebeliðin evresine göre tanýya kolay ulaþmak için önem kazanmaktadýr.

Anahtar Kelimeler: Akut apandisit, gebelik; nötrofil lenfosit oraný; platelet lenfosit oraný.

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Efficacy of laboratory tests and ultrasonography in the diagnosis of acute appendicitis in gravid patients according to the stages of pregnancy

Adil Baþkýran¹, Volkan Ýnce¹, Egemen Çiçek¹, Tolga Þahin¹, Abuzer Dirican¹, Ýpek Balýkçý Çiçek², Burak Iþýk¹, Sezai Yýlmaz^1
1Ýnönü University, Institute of Liver Transplantation, Turgut Özal Medical Center, Malatya, Turkey
²Department of Biostatistics and Bioinformatics, Ýnönü University Faculty of Medicine, Malatya, Turkey

BACKGROUND: Normal physiologic changes during pregnancy result in similar laboratory and symptomatology changes as those during acute appendicitis (AA), making the diagnosis extremely difficult. The aim of the present study was to analyze the efficacy of conventional laboratory and radiologic tests in the diagnosis of AA according to different stages of pregnancy.
METHODS: Twenty-five pregnant patients with pathologically confirmed AA operated at our department between 2012 and 2017 were retrospectively analyzed in terms of changes in conventional laboratory parameters as well as neutrophil-to lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios to aid the diagnosis of AA according to different stages of pregnancy.
RESULTS: There were no significant changes in C-reactive protein levels, leukocyte and neutrophil counts, and accuracy of ultrasonography between patients in the first (group 1) and second + third trimesters (group 2) (p>0.05). Lymphocyte count was significantly lower (p>0.05), whereas NLR and PLR were significantly higher in group 2 (p<0.05).
CONCLUSION: Laboratory values change significantly during pregnancy, and NLR and PLR seems to be valuable tools for evaluating AA in a stage-specific manner in pregnant patients.

Keywords: Acute appendicitis, neutrophil-to-lymphocyte ratio; platelet-to-lymphocyte ratio; pregnancy.

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