妊娠30週の急性虫垂炎に対して腹腔鏡下虫垂切除術を施行した1例

Laparoscopic appendectomy for appendicitis in a 30-week pregnant patient

◆要旨：妊娠中の虫垂炎に対する腹腔鏡下手術は報告例が少なく，特に妊娠後期の症例は，本邦ではまだ報告がない．今回，妊娠30週の妊婦の急性虫垂炎に対して腹腔鏡下虫垂切除を施行した1例を経験した．患者は34歳，女性．妊娠30週．右側腹部痛，嘔吐を主訴に当院を受診し，急性虫垂炎と診断した．妊娠後期ではあったが，視野確保，侵襲性，整容面のメリットを考慮して，腹腔鏡下手術を選択した．体位，トロッカー挿入部位を工夫することで良好な視野が得られ，子宮を圧迫することなく，安全に手術を行うことができた．術後経過は問題なく，後日，正常経腟分娩で無事出産した．腹腔鏡下虫垂切除術は，妊娠後期の症例でも安全に施行可能と考えられた．

There are few reports of laparoscopic appendectomy for appendicitis in pregnant patients in Japan, especially during the third trimester of pregnancy. We experienced laparoscopic appendectomy for appendicitis in a 30-weeks pregnant patient. The patient was 34 years old and in 30-weeks of gestation. Chief complaints were right flank pain and vomiting. We diagnosed as acute appendicitis. We chose laparoscopic appendectomy in the aspect of operative view, invasiveness and cosmetic reason. By proper postural positioning and trocar insert positions, we could achieve a good operative view and perform the operation safely without damaging the uterus. There was no complications during the perioperative course. She was discharged on postoperative day 5 and delivered without problems, later. It is thought that laparoscopic appendectomy could be done safely for appendicitis in the third trimester of pregnancy.