妊娠15週の妊婦に対し腹腔鏡下虫垂切除術を施行した1例

A case of laparoscopic appendectomy for a patient in the 15th week pregnancy

◆要旨：妊婦に対する虫垂切除の術式は，分娩時の腹圧上昇や妊婦・胎児への負担軽減を考えると腹腔鏡下手術が望ましいが，その報告例は少ない．今回筆者らは，妊娠15週の妊婦に対し腹腔鏡下虫垂切除術を安全に施行できた．患者は37歳，女性．妊娠15週に増悪する腹痛に対して，腹部CT検査で急性虫垂炎と診断し手術を行う方針とした．出産時の影響を考慮し，また妊娠15週で子宮底が臍下にあり視野確保可能と判断し，腹腔鏡下手術で虫垂を切除した．術後経過も問題なく，術後5日目に退院となった．今回の症例で，腹腔鏡下虫垂切除は妊婦に対して週数によっては十分安全に施行できると考えられた．

A laparoscopic surgery for pregnant patients with appendicitis could be better than open surgery because a small incision would make less impact at the time of delivery. However, only few cases are reported. In this paper, we report the laparoscopic appendectomy for a 37 year old female in the 15th week of pregnancy. The patient visited the hospital due to abdominal pain, and we diagnosed as an acute appendicitis by computerized tomography（CT） scan. We performed laparoscopic appendectomy because CT scan showed her fundus of the uterus was below the umbilicus, thus we expected enough room for the procedure. The patient was discharged on day 5 uneventfully. Laparoscopic surgery is a good option for the pregnant patients depending on the number of weeks in pregnancy.