Hata Tsuyoshi, Hayashi Nobuyasu, Urabe Shoichiro, Hayashi Koji, Nakagawa Tomo, Michiura Toshiya, Yamabe Kazuo
Department of Surgery, Kinan Hospital, Tanabe, Wakayama, Japan.
J Surg Case Rep. 2020 Jun 15;2020(6):rjaa097. doi: 10.1093/jscr/rjaa097. eCollection 2020 Jun.
Current guidelines indicate that laparoscopic appendectomies are safe for pregnant patients with acute appendicitis. Recently, single- and reduced-port laparoscopic surgeries have gained popularity for nonpregnant patients, because they minimize abdominal wall trauma. Here, we describe a reduced-port laparoscopic appendectomy (RPLA) in a 31-year-old pregnant female performed at 27 weeks gestational age. Preoperative abdominal ultrasonography and computed tomography imaging showed an inflamed, swollen appendix and blood test results showed elevations in the white blood cell count and the C-reactive protein level. Accordingly, acute appendicitis was diagnosed. A surgical incision was performed at the umbilicus with an EZ-access device; an additional 5-mm trocar was placed at the right lower quadrant. Recovery was uneventful. The patient was discharged 8 days postoperatively. A vaginal delivery was achieved at term. The RPLA was a good surgical option for minimizing surgical invasiveness, without increasing the technical difficulty, in conditions where the uterus and fetus are growing.
当前指南表明,腹腔镜阑尾切除术对于患有急性阑尾炎的孕妇是安全的。最近,单孔和减少切口的腹腔镜手术在非孕妇中越来越受欢迎,因为它们能将腹壁创伤降至最低。在此,我们描述了一例在孕27周时为一名31岁孕妇实施的减少切口腹腔镜阑尾切除术(RPLA)。术前腹部超声和计算机断层扫描成像显示阑尾发炎、肿胀,血液检查结果显示白细胞计数和C反应蛋白水平升高。据此,诊断为急性阑尾炎。使用EZ接入装置在脐部做一个手术切口;在右下腹再放置一个5毫米的套管针。恢复过程顺利。患者术后8天出院。足月时成功进行了阴道分娩。在子宫和胎儿不断生长的情况下,RPLA是一种既能将手术侵袭性降至最低,又不会增加技术难度的良好手术选择。