Halkic Nermin, Tempia-Caliera Adrien A, Ksontini Riadh, Suter Michel, Delaloye Jean-François, Vuilleumier Henri
Service de Chirurgie, CHUV, University of Lausanne, Lausanne 1011, Switzerland.
Langenbecks Arch Surg. 2006 Sep;391(5):467-71. doi: 10.1007/s00423-006-0069-x. Epub 2006 Aug 15.
Laparoscopic surgery during pregnancy is a challenging procedure that most surgeons are reluctant to perform. The objective of this study was to evaluate whether laparoscopic appendectomy and cholecystectomy is safe in pregnant women. The management of these situations remains controversial. We report a single center study describing the successful management of 16 patients during pregnancy.
More than 3,356 laparoscopic procedures were performed in our institutions between May 1990 and June 2005. Sixteen of these patients were operated on in the second and third trimester between 22 and 32 weeks of estimated gestational age. We performed 11 laparoscopic appendectomies and 5 laparoscopic cholecystectomies. We also reviewed the management and operative technique used in these patients.
In this study, the laparoscopic appendectomy or cholecystectomy was performed successfully in all patients. Three patients were in their second trimester, weeks 22, 23, and 25, and 13 were in the third trimester, weeks 27 (three patients), 28 (five patients), 31 (three patients), and 32 (two patients). No maternal or fetal morbidity occurred. Open laparoscopy was performed safely in all patients and all patients delivered healthy babies.
From our experience laparoscopic management of appendicitis and biliary colic during pregnancy is safe, however the second trimester is preferable for laparoscopic cholecystectomy. Pregnancy is not a contraindication to the laparoscopic approach to appendicitis or symptomatic cholelithiasis. We believe that laparoscopic operations, when performed by experienced surgeons, are safe and even preferable for the mother and the fetus.
孕期腹腔镜手术是一项具有挑战性的操作，大多数外科医生不愿实施。本研究的目的是评估腹腔镜阑尾切除术和胆囊切除术对孕妇是否安全。这些情况的处理仍存在争议。我们报告一项单中心研究，描述了16例孕期患者的成功处理情况。
1990年5月至2005年6月期间，我们机构共进行了3356例以上的腹腔镜手术。其中16例患者在妊娠中期和晚期进行手术，估计孕周在22至32周之间。我们实施了11例腹腔镜阑尾切除术和5例腹腔镜胆囊切除术。我们还回顾了这些患者所采用的处理方法和手术技巧。
在本研究中，所有患者的腹腔镜阑尾切除术或胆囊切除术均成功实施。3例患者处于妊娠中期，孕周分别为22、23和25周，13例处于妊娠晚期，孕周分别为27周（3例患者）、28周（5例患者）、31周（3例患者）和32周（2例患者）。未发生母体或胎儿并发症。所有患者均安全地进行了开放式腹腔镜检查，所有患者均分娩出健康婴儿。
根据我们的经验，孕期腹腔镜处理阑尾炎和胆绞痛是安全的，然而妊娠中期更适合进行腹腔镜胆囊切除术。妊娠并非腹腔镜治疗阑尾炎或有症状胆结石的禁忌证。我们认为，由经验丰富的外科医生进行腹腔镜手术对母亲和胎儿来说是安全的，甚至更可取。
