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妊娠期腹腔镜检查:各国指南的比较综述

Laparoscopy in Pregnancy: A Comparative Review of National Guidelines.

作者信息

Michos Georgios, Dagklis Themistoklis, Papanikolaou Evangelos, Peitsidis Nikolaos I, Kalogiannidis Ioannis A, Mamopoulos Apostolos M, Athanasiadis Apostolos

机构信息

Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC.

Private IVF Unit, Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, GRC.

出版信息

Cureus. 2023 May 11;15(5):e38904. doi: 10.7759/cureus.38904. eCollection 2023 May.

Abstract

Gynecological and general surgical conditions requiring surgical management during pregnancy constitute a medical challenge, which often entails the collaboration of numerous medical specialties. In recent years, laparoscopy in pregnancy has been accepted as a safe alternative to open surgery. This has led gynecological societies to conduct studies and issue guidelines related to laparoscopy in pregnancy, with a view to assisting and guiding clinicians and surgeons. The aim of this study was to review and compare the recommendations from various published national guidelines on laparoscopy in pregnant women. To that end, a descriptive review of guidelines from the British Society for Gynaecological Endoscopy (BSGE), the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the Society of Obstetricians and Gynaecologists of Canada (SOCG), and the Collège National des Gynécologues et Obstétriciens Français (CNGOF) was conducted. Regarding diagnosis, the SAGES and SOCG societies recommend ultrasound as the preferred and safe imaging technique during pregnancy. In terms of the optimal timing for laparoscopic intervention, BSGE and SAGES do not restrict the laparoscopic approach based on safety, depending on the gestation week, whereas SOCG and CNGOF propose early second trimester and first and second quarter of pregnancy respectively. There is an overall consensus regarding patient positioning, initial port placement, insufflation pressure during the operation, venous thromboembolic (VTE) prophylaxis, fetal heart monitoring, and tocolysis among the reviewed guidelines. Moreover, only the BSGE mentions the need for corticosteroids, magnesium sulfate, and anti-D prophylactic administration.

摘要

孕期需要手术治疗的妇科及普通外科疾病是一项医学挑战,通常需要多个医学专科协作。近年来,孕期腹腔镜检查已被公认为开放性手术的一种安全替代方法。这促使妇科协会开展相关研究并发布有关孕期腹腔镜检查的指南,以协助和指导临床医生及外科医生。本研究的目的是回顾和比较各国已发表的关于孕妇腹腔镜检查的指南中的建议。为此,对英国妇科内镜学会(BSGE)、美国胃肠及内镜外科医师学会(SAGES)、加拿大妇产科学会(SOCG)以及法国国家妇产科医师学会(CNGOF)的指南进行了描述性综述。关于诊断,SAGES和SOCG学会推荐超声作为孕期首选且安全的成像技术。在腹腔镜干预的最佳时机方面,BSGE和SAGES并不基于安全性依据孕周限制腹腔镜手术方式,而SOCG和CNGOF分别建议在孕中期早期以及妊娠的第一和第二季度进行。在所审查的指南中,对于患者体位、初始穿刺孔位置、手术期间的气腹压力、静脉血栓栓塞(VTE)预防、胎儿心率监测以及宫缩抑制方面总体达成了共识。此外,只有BSGE提到了使用皮质类固醇、硫酸镁和抗-D预防用药的必要性。

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