Uchino Motoi, Ikeuchi Hiroki, Matsuoka Hiroki, Bando Toshihiro, Hirose Kei, Hirata Akihiro, Chohno Teruhiro, Sasaki Hirofumi, Yokoyama Yoko, Nakamura Shiro, Nakamura Yuko, Takesue Yoshio
Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Kakogawa, Japan.
Department of Gastroenterology, Kakogawa West City Hospital, Kakogawa City Hospital Foundation, Kakogawa, Japan.
Case Rep Gastroenterol. 2015 Mar 27;9(1):74-80. doi: 10.1159/000381141. eCollection 2015 Jan-Apr.
Refractory ulcerative colitis (UC) that does not respond to medical therapy often requires surgery even during pregnancy. Although surgical cases of UC during pregnancy were reported previously, the standard surgical strategy for both colitis and pregnancy was unclear. Herein, fetal and maternal safety as well as the strategy for this unusual surgical procedure during pregnancy in patients with UC are considered. A 28-year-old woman was diagnosed with left-sided moderate UC at 12 weeks of pregnancy; toxic megacolon was suspected, and surgery was required. Although the baby's gestational age was 23 weeks and 3 days, a cesarean section was performed before the colectomy. In a next case, a 28-year-old woman had a 2-year history of left-sided UC. Her colitis flared up at 11 weeks of pregnancy. Colectomy was performed because her colitis was unresponsive to conservative therapy, and the pregnancy was continued, with a transvaginal delivery at 36 weeks. In patients with UC, the need for surgery should be determined promptly based on disease severity, whether or not the patient is pregnant. The need for surgery should not be affected by pregnancy. The pregnancy should be continued for as long as possible when there are no fetal and maternal complications. Both cesarean section and colectomy should be performed independently if necessary.
对药物治疗无反应的难治性溃疡性结肠炎（UC）即使在孕期通常也需要手术。尽管此前有孕期UC手术病例的报道，但针对结肠炎和孕期的标准手术策略尚不清楚。在此，我们考虑了UC患者孕期这种特殊手术操作的胎儿和母亲安全以及策略。一名28岁女性在妊娠12周时被诊断为左侧中度UC；怀疑发生中毒性巨结肠，需要进行手术。尽管婴儿的孕周为23周零3天，但在结肠切除术之前先进行了剖宫产。在另一个病例中，一名28岁女性有左侧UC病史2年。她的结肠炎在妊娠11周时发作。由于她的结肠炎对保守治疗无反应，进行了结肠切除术，并继续妊娠，在36周时经阴道分娩。对于UC患者，应根据疾病严重程度以及患者是否怀孕迅速确定手术需求。手术需求不应受妊娠影响。在无胎儿和母亲并发症的情况下，应尽可能延长孕期。如有必要，剖宫产和结肠切除术应分别进行。
