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1、Laparoscopicsurgeryduringpregnancy妊娠期间腹腔镜手术YuenPongMo阮邦武Consultant&DirectorofGynaecologicalEndoscopy,DepartmentofObstetricsandGynaecology,PrinceofWalesHospital,HongKongHonoraryClinicalAssociateProfessor,DepartmentofObstetricsandGynaecology,TheChineseUniversityofHongKong,HongKongPresiden
2、t,TheHongKongGynaecologicalEndoscopySocietyTheadvanceintechnologyandskillsinoperativelaparoscopyhasrevolutionizedthesurgicalapproachtomanydifferentproceduresingynecologyandothersurgicalspecialties.Manyconditionsthatwerepreviouslyconsideredasacontraindicationtolaparoscopycannowbeoperated
3、onusingthisapproach.Pregnancy,especiallyinmoreadvancedgestation,wasconsideredasanabsolutecontraindicationforlaparoscopy.Thisisprobablybecauseofthefearofinjurytotheenlargedpregnantuterus,resultinginleakageofamnioticfluid,bleeding,abortionandevengasembolism.Thecreationofpneumoperitoneuman
4、dtheuseofcarbondioxidemaydecreaseuterinebloodflow,resultinginfetalhypotension,hypoxiaandacidosis.Therelativelackofspaceavailableforsurgicalmanipulationfurtherlimitsthepossibleproceduresthatcanbeperformed.However,overthelastdecade,moreandmorecasereportsandretrospectivestudieshaveappeared
5、andreportedthesafetyofoperativelaparoscopyduringpregnancy.Non-obstetricsurgeryisperformedin1.6-2.2%ofpregnantwomen,butoperativelaparoscopyduringpregnancyhasbeenlimitedlargelytoappendcectomy,cholcystectomyandremovalofadnexalmass.LaparoscopicAdnexalSurgeryThereportedincidenceofadnexalmass
6、complicatingpregnancyrangesfrom1in81to1in2,500livebirths,withanaverageof1in600.Corpuslutealcystsaccountforathirdoftheadnexalmassesandbenigncysticteratomascontributetoanotherthird.Surgicalremovalofthemassduringpregnancyisassociatedwithasignificantincreaseinfetalloss,especiallywhenperform
7、edduringthefirsttrimesterorinanemergentsituation.Ithasbeensuggestedthatallpersistentadnexalmassesshouldbeelectivelyremovedatsecondtrimestertoavoiddelayinthediagnosisofapossiblemalignancyandtoavoidtheriskofcomplications,asfunctionalcorpuslutealcystwouldhaveregressedbythen.Theinc
