妊娠後期の急性虫垂炎に対して腹腔鏡補助下虫垂切除術を行った1例

A case of laparoscopic assisted appendicectomy for acute appendicitis in late pregnancy

◆要旨：症例は30歳，妊娠29週の女性．急性虫垂炎の診断で紹介され緊急手術を行った．左半側臥位，3本トロカーでの腹腔鏡手術を開始したが，working spaceが狭く，副損傷や手術時間の延長が危惧されたため，右側腹部の創を20mmに延長して小開腹し，体腔外で虫垂を切除した．術後経過は良好で妊娠38週に出産した．腹腔鏡手術は開腹手術と比べて侵襲が少なく，妊娠期でも子宮を圧排することなく腹腔内全体を観察できることが利点である．妊娠後期の急性虫垂炎に対する治療として，まず腹腔鏡手術を行うことで虫垂の同定が可能であり，腹腔鏡下に完遂できなくても，最低限の追加切開で虫垂切除が可能となるため有用であると考える．

　The patient was a 30-year-old woman who was 29 weeks pregnant. The patient was referred with a diagnosis of acute appendicitis. Emergency surgery was performed. Laparoscopic surgery was performed with 3 ports in the left semi-lateral position. Because of little working space and apprehensions of collateral damage and prolongation of the surgery time and pneumoperitoneum time, the port wound on the right side of the abdomen was lengthened to 20 mm and a small laparotomy was performed. The appendix was removed outside the body. Compared to open surgery, laparoscopic surgery has the advantages of smaller incisions, better cosmetic results, less postoperative pain, and the ability to thoroughly observe the inside of the abdominal cavity without compressing the uterus. The postoperative course was uneventful, and the baby was delivered vaginally at 38 weeks of pregnancy. There are still few reports of acute appendicitis in late pregnancy, and it is necessary to accumulate and study more cases, but it seems useful to try laparoscopic surgery.