妊娠36週に腹腔鏡下胆囊摘出術を施行した症候性胆石症の1例

A case of laparoscopic cholecystectomy in the 36 weeks of gestation

◆要旨：症候性胆石症の妊婦に施行される腹腔鏡下胆囊摘出術（laparoscopic cholecystectomy：以下，LC）は妊娠28週未満で行われることが多い．今回，筆者らは妊娠36週の妊婦に対するLCを安全に施行しえたので報告する．症例は26歳，初産婦．妊娠30週に心窩部痛が出現し，胆囊結石症の診断で保存的加療を開始した．症状の改善を認めたが，妊娠32週に症状が再燃したため再入院し，以後，食事摂取のたびに胆石発作を繰り返すため，妊娠36週でLCを施行した．術中気腹圧は7mmHgとし，妊娠子宮は胆囊摘出操作の妨げにならず，良好な視野が確保できた．術後経過は良好で，合併症なく妊娠40週で健康な男児を出産した．

　A 26-year-old woman at 30 weeks of gestation was admitted to our hospital because of epigastric pain. Her condition improved with conservative treatment. At 32 weeks of gestation, she experienced repeated epigastric pain frequently after meals and could not take meals. Since malnutrition of the mother might cause fetal growth retardation, cholecystectomy was recommended before delivery. At 36 weeks of gestation, laparoscopic cholecystectomy was performed under intra-abdominal CO₂ insufflation pressures maintained at less than 7mmHg. The pregnant uterus did not disturb the view even under low pressure. Surgery was successful and the postoperative course was uneventful. She was discharged on the 10th postoperative day. She delivered a healthy baby at 40 weeks of gestation. Laparoscopic cholecystectomy for pregnant women with symptomatic cholelithiasis is commonly indicated if they are in less than 28 weeks of gestation. We report a case of laparoscopic cholecystectomy safely performed for a woman with symptomatic cholelithiasis at 36 weeks of gestation.