Guterman S, Mandelbrot L, Keita H, Bretagnol F, Calabrese D, Msika S
Service de gynécologie-obstétrique, hôpital Louis-Mourier, hôpitaux universitaires Paris-Nord Val de Seine, Assistance publique-Hôpitaux de Paris, 178, rue des Renouillers, 92700 Colombes, France; Université Paris Diderot, université Sorbonne Paris-Cité, 75018 Paris, France; Département hospitalier universitaire risques et grossesse, 75018 Paris, France.
Service de gynécologie-obstétrique, hôpital Louis-Mourier, hôpitaux universitaires Paris-Nord Val de Seine, Assistance publique-Hôpitaux de Paris, 178, rue des Renouillers, 92700 Colombes, France; Université Paris Diderot, université Sorbonne Paris-Cité, 75018 Paris, France; Département hospitalier universitaire risques et grossesse, 75018 Paris, France.
J Gynecol Obstet Hum Reprod. 2017 May;46(5):417-422. doi: 10.1016/j.jogoh.2017.03.008. Epub 2017 Mar 31.
To assess complications and outcomes of pregnancies following laparoscopic abdominal surgery during the second and third trimesters of pregnancy.
Retrospective single-center study of 23 cases of laparoscopic surgery in the second or third trimesters of pregnancy between January 2005 and May 2016.
The laparoscopies were performed between 15 and 33 weeks of gestation, a mean of 23 weeks+2 days, with 6 cases in the 3rd trimester. The operations were: 11 cholecystectomies, 6 appendectomies, 1 intestinal occlusion (volvulus on a gastric band), 3 adnexal torsions, 1 ovarian cyst and 1 paratubal cyst with torsion. No secondary laparotomy was required. The postoperative courses were favorable in most cases. However, 3 appendectomies were complicated, one by chorioamnionitis and miscarriage at 20½ weeks of gestation and 2 by right iliac fossa abscesses requiring percutaneous radiological drainage, one of these women delivered a healthy term baby and the other had chorioamnionitis and preterm delivery at 34 weeks, followed by neonatal death.
Laparoscopy can be safely performed for surgical indications in the second and third trimesters of pregnancy. In case of abdominal symptoms, a timely diagnosis is required to decide whether or not to operate and imaging should not be withheld particularly in case of suspected appendicitis which has a high risk of complications.
评估妊娠中晚期腹腔镜腹部手术后妊娠的并发症及结局。
对2005年1月至2016年5月期间23例妊娠中晚期腹腔镜手术病例进行回顾性单中心研究。
腹腔镜手术在妊娠15至33周进行，平均孕周为23周+2天，其中6例为孕晚期手术。手术类型包括：11例胆囊切除术、6例阑尾切除术、1例肠梗阻（胃束带扭转）、3例附件扭转、1例卵巢囊肿和1例输卵管旁囊肿扭转。无需二次剖腹手术。大多数病例术后病程良好。然而，3例阑尾切除术出现并发症，1例在妊娠20.5周时并发绒毛膜羊膜炎和流产，2例右侧髂窝脓肿需经皮放射引流，其中1例产妇足月分娩一健康婴儿，另1例产妇在34周时并发绒毛膜羊膜炎和早产，随后新生儿死亡。
妊娠中晚期因手术指征行腹腔镜手术可安全进行。出现腹部症状时，需及时诊断以决定是否手术；尤其在怀疑阑尾炎且并发症风险高时，不应拒绝影像学检查。
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