妊娠中期に内視鏡的総胆管結石砕石術および腹腔鏡下胆囊摘出術を施行した1例

A case of laparoscopic cholecystectomy after endoscopic choledocholithotomy for mid-pregnant woman

◆要旨：患者は30代，女性．妊娠7週目に心窩部痛を認め，急性胆管炎の診断で緊急入院となり，内視鏡的胆道ステント留置術を施行後，軽快退院となったが，妊娠14週目に胆管炎が再燃した．保存的に軽快したが妊娠20週目に胆石発作にて3度目の入院となった．胆石発作，胆管炎を頻回に繰り返しており，今後の胎児への影響を考慮し内視鏡的総胆管結石砕石術を施行後，妊娠21週目に腹腔鏡下胆囊摘出術を施行した．経過は良好で胎児への影響もなく，術後5日目に軽快退院となり，妊娠39週目に健児を出産した．妊娠中期における胆石・総胆管結石に対して内視鏡的，外科的処置を安全に施行することができた．

　A 30's woman in 7th week of pregnancy visited our hospital for epigastralgia and nausea. Because of acute cholangitis due to choledocholiths, she was admitted in emergency. By endoscopic retrograde biliary drainage, she improved and was discharged, However, she was repeatedly admitted at 14th and 20th week of pregnancy due to acute cholangitis and gallstone attack. Because she was admitted three times until mid-pregnancy, we performed laparoscopic cholecystectomy following endoscopic choledocholithotomy without complication. At 39th week of pregnancy, she gave birth to a healthy baby. It was suggested that endoscopic and surgical treatments for gallbladder stone and choledocholiths could be safely performed for mid-pregnant woman.