Gouldman J W, Sticca R P, Rippon M B, McAlhany J C
Department of Surgical Education, Greenville Hospital System, SC 29605, USA.
Am Surg. 1998 Jan;64(1):93-7; discussion 97-8.
Laparoscopic cholecystectomy has been performed in the United States since 1989 and currently is the procedure of choice for the management of symptomatic cholelithiasis. Its utility in the pregnant patient has been controversial. Concerns have been expressed for a number of potential problems, including trocar injury to uterus and fetus, effect of pneumoperitoneum on both mother and fetus, induction of preterm labor, teratogenic effects on the fetus, and long-term effects on fetal and neonatal development. We describe the Greenville Hospital System experience with laparoscopic cholecystectomy in pregnancy. From 1992 to 1996, eight laparoscopic cholecystectomies were performed in pregnant females, one during the first trimester and seven during the second trimester. Mean maternal age was 23.8 years (range, 18-31). All procedures were performed for recurrent and intractable symptoms with the average length of symptoms 3.5 weeks (range, 2-4 weeks). Two patients were diagnosed preoperatively with gallstone pancreatitis, two had acute cholecystitis, and four patients were felt to have hyperemesis gravidarum before their diagnosis of gallstones. All procedures were performed under general endotracheal anesthesia with CO2 insufflation pressures of 12 mm Hg. Postoperatively, all patients had uneventful recoveries with complete resolution of their symptoms and were discharged home in an average of 3 days (range, 1-7 days). No postoperative complications to mother or fetus were documented. Eight patients have delivered full-term healthy fetuses with no documented neonatal morbidity or mortality. Long-term follow-up of the infants at a mean of 23 months (range, 2.5-47 months) reveals that all eight infants have progressed to normal healthy children. Our experience and the current world literature demonstrate that laparoscopic cholecystectomy in pregnancy can be performed safely and effectively for symptomatic cholelithiasis, especially when symptoms are recurrent and persistent and may endanger fetal and maternal livelihood. The diagnosis of symptomatic cholelithiasis should be considered in the pregnant patient with recurrent episodes of nausea and vomiting.
自1989年以来，腹腔镜胆囊切除术在美国已得到开展，目前是治疗有症状胆结石的首选术式。其在孕妇中的应用一直存在争议。人们对一些潜在问题表示担忧，包括套管针损伤子宫和胎儿、气腹对母亲和胎儿的影响、诱发早产、对胎儿的致畸作用以及对胎儿和新生儿发育的长期影响。我们描述了格林维尔医院系统在孕妇中开展腹腔镜胆囊切除术的经验。1992年至1996年期间，对8名孕妇实施了腹腔镜胆囊切除术，其中1例在孕早期，7例在孕中期。孕妇平均年龄为23.8岁（范围18 - 31岁）。所有手术均针对复发性和顽固性症状进行，症状平均持续时间为3.5周（范围2 - 4周）。2例患者术前诊断为胆石性胰腺炎，2例为急性胆囊炎，4例患者在诊断胆结石之前被认为患有妊娠剧吐。所有手术均在全身气管内麻醉下进行，二氧化碳气腹压力为12 mmHg。术后，所有患者恢复顺利，症状完全缓解，平均3天（范围1 - 7天）出院。未记录到对母亲或胎儿的术后并发症。8名患者均足月分娩出健康胎儿，未记录到新生儿发病或死亡情况。对婴儿平均23个月（范围2.5 - 47个月）的长期随访显示，所有8名婴儿均成长为正常健康儿童。我们的经验以及当前的世界文献表明，对于有症状的胆结石，妊娠期间进行腹腔镜胆囊切除术可以安全有效地实施，尤其是当症状复发且持续并可能危及胎儿和母亲的生命时。对于反复出现恶心和呕吐的孕妇，应考虑有症状胆结石的诊断。
