Rege Sameer Ashok, Roshan Chiranjeev, Siddhant Vairagar, Shrinivas Surpam, Ajinkya Rewatkar
Department of General Surgery, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India.
J Minim Access Surg. 2020 Jan-Mar;16(1):54-58. doi: 10.4103/jmas.JMAS_145_18.
Laparoscopic techniques have been used during pregnancy by obstetricians since the 1970's, primarily to diagnose and treat ectopic and heterotopic pregnancies. Pregnancy was considered as an absolute contraindication to laparoscopy by surgeons as recently as 1991, and a few still doubt the safety of minimal access in gravid patients. When an emergent operation is indicated, the surgery should not be withheld on the sole basis of patient's gravid state. On the contrary, the alleviation of maternal disease is thought to take priority because the health of the foetus is dependant on the mother.
This is a retrospective study of a case series of 18 obstetric patients who presented with non-obstetric causes of acute abdomen requiring surgical intervention. Ultrasonography and magnetic resonance imaging (MRI) along with other laboratory investigations were carried out to reach the diagnosis. Laparoscopic surgery was considered as the modality of treatment. All the patients were given the necessary care post-surgery and were followed up till parturition to look for any complications.
The data were analysed considering the presentation, diagnostic variations and the surgical modifications statistically.
The decision of surgery should be prompt and should be weighed against complications of conserving the patient. Due to the diagnostic limitations of ultrasonography, MRI should be coupled to confirm the diagnosis. Laparoscopy offers less analgesic requirements and shorter hospital stay. The operative time is highly subjective to the experience and training of the surgeon and the laparoscopic set-up itself.
自20世纪70年代以来，产科医生就已在孕期使用腹腔镜技术，主要用于诊断和治疗异位妊娠和子宫外孕。直到1991年，外科医生仍将妊娠视为腹腔镜检查的绝对禁忌证，现在仍有一些人怀疑妊娠患者进行微创手术的安全性。当需要进行急诊手术时，不应仅因患者处于妊娠期而不进行手术。相反，减轻母体疾病被认为更为重要，因为胎儿的健康依赖于母亲。
这是一项对18例产科患者的病例系列回顾性研究，这些患者因非产科原因导致急腹症需要手术干预。通过超声检查、磁共振成像（MRI）以及其他实验室检查来做出诊断。腹腔镜手术被视为治疗方式。所有患者术后均得到必要的护理，并随访至分娩，以查找任何并发症。
对数据进行了统计分析，考虑了临床表现、诊断差异和手术改良情况。
手术决策应迅速，并应权衡保留患者所带来的并发症。由于超声检查存在诊断局限性，应结合MRI来确诊。腹腔镜手术所需镇痛较少，住院时间较短。手术时间很大程度上取决于外科医生的经验和培训以及腹腔镜设备本身。
