Curet M J, Allen D, Josloff R K, Pitcher D E, Curet L B, Miscall B G, Zucker K A
Department of Surgery, University of New Mexico, School of Medicine, Albuquerque, USA.
Arch Surg. 1996 May;131(5):546-50; discussion 550-1. doi: 10.1001/archsurg.1996.01430170092017.
To compare the safety and efficacy of laparoscopic surgery with that of open laparotomy in pregnant patients.
Six-year case-control study.
Tertiary care, university and community hospitals.
Population-based sample. From 1990 through 1995, 16 pregnant patients underwent laparoscopic surgery (study group) and 18 underwent open laparotomy (control group) during the first or second trimester. Follow-up ranged from 1 month to 6 years.
In the study group, 4 patients underwent appendectomies and 12 underwent cholecystectomies. The control group included 7 appendectomies and 11 cholecystectomies.
The 2 groups were compared for age, trimester, surgical time, oxygen saturation, end-tidal carbon dioxide, return of gastrointestinal tract function, duration of intravenous or intramuscular narcotics, postoperative stay, gestational age of delivery, 1- and 5-minute Apgar scores, birth weights, and complications.
Age, trimester, oxygenation, end-tidal CO2, gestational age at delivery, Apgar scores, and birth weights were not different between the 2 groups. The patients who underwent laparoscopy had significantly longer operative times 82 vs 49 minutes), shorter stay (1.5 vs 2.8 days), earlier resumption of regular diet (1.0 vs 2.4 days), and shorter duration of intravenous or intramuscular narcotics (1.2 vs 2.6 days) (all P < .01). Four complications were found in the laparotomy group vs 6 in the laparoscopy group.
Laparoscopic surgery in pregnant women significantly decrease hospitalization, decreases narcotic use, and quickens return to a regular diet when compared with open laparotomy in pregnant women. No significant differences between the 2 groups in perioperative morbidity or mortality were present. These data suggest that therapeutic laparoscopy during pregnancy in the first or second trimester is safe.
比较腹腔镜手术与开腹手术对妊娠患者的安全性和有效性。
为期六年的病例对照研究。
三级医疗、大学及社区医院。
基于人群的样本。1990年至1995年期间，16例妊娠患者在孕早期或孕中期接受了腹腔镜手术（研究组），18例接受了开腹手术（对照组）。随访时间为1个月至6年。
研究组中，4例患者接受了阑尾切除术，12例接受了胆囊切除术。对照组包括7例阑尾切除术和11例胆囊切除术。
比较两组患者的年龄、孕周、手术时间、血氧饱和度、呼气末二氧化碳分压、胃肠道功能恢复情况、静脉或肌肉注射麻醉药的使用时间、术后住院时间、分娩时的孕周、1分钟和5分钟阿氏评分、出生体重及并发症。
两组患者的年龄、孕周、氧合情况、呼气末二氧化碳分压、分娩时的孕周、阿氏评分及出生体重无差异。接受腹腔镜手术的患者手术时间明显更长（82分钟对49分钟），住院时间更短（1.5天对2.8天），恢复正常饮食更早（1.0天对2.4天），静脉或肌肉注射麻醉药的使用时间更短（1.2天对2.6天）（所有P<0.01）。开腹手术组发现4例并发症，腹腔镜手术组发现6例并发症。
与开腹手术相比，妊娠患者的腹腔镜手术显著缩短了住院时间，减少了麻醉药的使用，并加快了恢复正常饮食的速度。两组围手术期发病率或死亡率无显著差异。这些数据表明，孕早期或孕中期进行治疗性腹腔镜手术是安全的。
