晚孕期腹腔镜手术4例报告及文献复习

目的探讨妊娠晚期妇科腹腔镜手术的可行性。方法回顾性分析2009~2015年北京大学第一医院妇产科收治的4例晚孕期因附件包块住院、行腹腔镜手术治疗患者的临床资料,并随访其妊娠结局和新生儿情况。结果 4例患者的孕周为28+2~31+5周,临床表现均为急腹症,疑诊附件包块扭转而行腹腔镜手术,病理诊断为3例输卵管系膜囊肿扭转坏死,1例为增大坏死的卵巢。术后出现宫缩予硫酸镁、吲哚美辛等保胎治疗成功,未发生手术相关合并症。4例患者均足月分娩,3例因产科因素行剖宫产,1例阴道顺产,新生儿无窒息。随访6周~6年,患者月经正常、肿物无复发,小儿发育良好。结论晚孕期腹腔镜手术风险相对较大,对于因附件包块而致急腹症的患者,在有条件的医疗机构,由有经验的内镜医生施术,不失为一种治疗方法。

Laparoscopic surgery for adnexal masses in the third trimester of pregnancy:4 cases report and literature review

Objective To explore the feasibility of laparoscopic surgery for adnexal masses in the third trimester of pregnancy. Methods Retrospectively analysed 4 cases of late term pregnancy women, laparoscopic surgery was performed because of torsion of adnexal mass during Jan 2009 to Dec 2015 in Peking University First Hospital. Followed up their pregnancy outcomes including the newborn. The literature was also reviewed meanwhile. Results All of the surgical procedures were successful, no complications due to the operations. The gestational age was 28 +2 ~31 +5 weeks, with acute abdominal pain as the beginning symptom. Adnexal torsions were diagnosed during the procedure, and salpingo-oophorectomy were performed in the 4 cases because of the severe infarction. The pregnancy outcomes were encouraged, 3 full-term c-section birth due to obstetric factors, 1 case of vaginal delivery. The newborn were normal during a follow -up from 6 week to 6 years. Conclusion Laparoscopic surgery is one of the choices for late term pregnancy women who have acute abdominal pain due to torsion or rupture of adnexal masses because of the advantages of fast recovery, favorable surgical and pregnancy outcomes.