Fabiani P, Bongain A, Persch M, Benizri E, Mouiel J, Gillet J Y
Service de Chirurgie Digestive, Hôpital St-Roch, Nice.
J Gynecol Obstet Biol Reprod (Paris). 1993;22(3):317-9.
Pregnancy used to be considered a contraindication for endoscopic surgery of the digestive tract. We report a case of cholecystectomy carried out laparoscopically for complicated gall stones in a woman who was 14 weeks pregnant. There was no post-operative maternal or fetal morbidity. The mother carried on the pregnancy to term normally and gave birth to a normal infant. The same results have been reported in the literature for three other cases of cholecystectomy and six of appendicectomy. The sole technical precautions that had to be undertaken were in introducing and placing the trocars, taking into account the size of the uterus. There has been no scientific proof that CO2 is toxic for the fetus. Clinical practice shows that endoscopic surgery is possible without any obstetrical risk including thrombo-emboli, nor specific sepsis occurring in any of the three trimesters of pregnancy. The advantages of the endoscopic approach are that there is less post-operative pain and therefore less need to take analgesics. There are no complications because of an abdominal wound and the patient can both feed and walk about immediately after the operation with a reduction of the time spent in hospital. There is probably less risk of aborting when compared with classical laparotomy. The endoscopic route can be chosen when surgery is needed in the digestive tract during pregnancy.
妊娠曾被视为消化道内镜手术的禁忌证。我们报告一例为一名怀孕14周的女性因复杂性胆结石行腹腔镜胆囊切除术的病例。术后母婴均未出现并发症。母亲正常妊娠至足月并产下一名正常婴儿。文献中还报道了另外3例胆囊切除术和6例阑尾切除术的相同结果。唯一需要采取的技术预防措施是在置入套管针时，要考虑子宫的大小。目前尚无科学证据表明二氧化碳对胎儿有毒性。临床实践表明，内镜手术可行，且不存在包括血栓栓塞在内的任何产科风险，孕期三个阶段中也未发生特定的败血症。内镜手术的优点是术后疼痛较轻，因此较少需要服用镇痛药。不会因腹部伤口出现并发症，患者术后可立即进食和走动，住院时间缩短。与传统剖腹手术相比，流产风险可能更低。孕期消化道需要手术时可选择内镜手术途径。
