腹腔镜手术治疗妊娠期急腹症28例

　　【摘要】 目的 探讨妊娠期急腹症的腹腔镜手术适用证和手术技巧。方法 对应用腹腔镜手术治疗的28例妊娠期急腹症患者的诊疗过程及随访结果进行回顾性分析。结果 28例中9例妊娠9～12周，19例妊娠13～20周。均行腹腔镜探查并手术治疗：卵巢囊肿蒂扭转13例，其中5例行囊肿剥除，8例行附件切除;子宫肌瘤蒂扭转2例;急性阑尾炎11例;急性胆囊炎2例。所有病例均获得随访，随访时间为18～30周;先兆流产2例，早产2例。结论 妊娠期急腹症采用腹腔镜手术治疗安全可靠，基本不影响妊娠过程和妊娠结局。

　　【关键词】 妊娠;急腹症;腹腔镜;手术治疗

　　Laparoscopic operation for 28 cases of acute abdomen in pregnancy

　　QIAO Qun1, WU Xinyong2, WANG Wenfei1, WANG Min1, ZHOU Wenlong1, JIA Fenghua2

　　(1.Department of Obstetrics and Gynecology, The People′s Hospital of Xinyi, Xinyi, Jiangsu 221400, China;

　　2. Department of General Surgery, The People′s Hospital of Xinyi)

　　Abstract: Objective To discuss the indications for laparoscopic operation for acute abdomen in pregnancy and the technical skills for the procedures.Methods A retrospective analysis was conducted on the clinical diagnosis and treatment as well as the follow-up of 28 cases of acute abdomen in pregnancy treated with laparoscopic operation. Results Of the 28 cases, 9 were pregnant for 9-12 weeks, and the other 19 were within 13-20 gestational weeks. All cases underwent laparoscopic probe for diagnosis and surgical therapy. There were 13 cases of torsion of ovarian pedicle, 5 of which were treated with cystectomy and 8 were treated with adnexectomy. In addition, there were 2 cases of pedicle torsion of hysteromyoma, 11 cases of appendicitis, and 2 cases of acute cholecystitis. Follow-up of 18-30 weeks showed that there were 2 cases of threatened abortion and 2 cases of premature delivery.Conclusion Laparoscopic operation for acute abdomen in pregnancy proved reliable and safe and usually do not affect the pregnancy process and result.

　　Key words： pregnancy; acute abdomen; laparoscopy; operation therapy

　　妊娠期急腹症，多见于妊娠早中期，如急性阑尾炎、急性胆囊炎、卵巢囊肿蒂扭转等，可危及母儿安危，必须采取手术治疗。妊娠期急腹症手术既要考虑到患者自身的疾病，又要考虑到胎儿的安全，因此探索安全有效的手术方法十分必要。传统的开腹手术治疗方式对腹腔环境干扰大，对胎儿的安全也有较大的影响。腹腔镜手术已广泛应用于临床，操作技术已成熟，创伤轻、对机体环境干扰小的优点是其应用于妊娠期急腹症手术治疗的可行性基础。1998年6月—20

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