妊娠17週の妊婦の急性虫垂炎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 acute appendicitis in a 17-week pregnant woman

◆要旨：妊婦に対して安全に腹腔鏡下虫垂切除術を施行しえた1例を経験したので報告する．患者は妊娠17週，30歳女性．腹痛を主訴に前医を受診し，急性虫垂炎が疑われたために当院へ紹介された．腹膜刺激症状が陽性であり，また腹部超音波にて虫垂の腫大を認め，急性虫垂炎と診断し手術の方針とした．本邦では妊婦に対する腹腔鏡下虫垂切除術の報告例が少なく現時点での適応には慎重であるべきだが，妊娠週数と子宮底の位置を考慮しポート配置を工夫することで妊娠中でも安全に行うことが可能で，有用な治療法の1つになりうると考えられた．

We safely performed laparoscopic appendectomy in a 30-year-old, 17-week pregnant woman. She visited a nearby doctor with a chief complaint of abdominal pain and was referred to our hospital with a diagnosis of acute appendicitis. Symptoms of peritoneal irritation were positive, and swelling of the appendix was confirmed by abdominal ultrasonography. We diagnosed her as having acute appendicitis and performed emergency surgery. In Japan, there are few reported cases of laparoscopic appendectomy in pregnant women. However, by devising a port arrangement that takes into account the number of weeks of pregnancy and the position of the uterine fundus, laparoscopic appendectomy can be performed safely even during pregnancy.