妊娠に合併した付属器腫瘍に対する腹腔鏡手術の検討

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Objective: To evaluate the safety and efficacy of laparoscopy compared to laparotomy for treatment of adnexal masses in pregnancy, with a particular attention to the pregnancy outcome. Design: Retrospective study. Setting: Private hospital. Patients: 19 women with adnexal masses in pregnancy. Interventions: Seven women who underwent laparoscopy and 12 women who underwent laparotomy from 2001 through 2010. Main outcome measures: We reviewed patient age, weight, gestational weeks at time of surgery, surgery time, blood loss, hospital stay, histology, tumor diameter, and pregnancy outcome. Results: The averages of the following were: age, 33.5 years; weight, 52.6 kg; gestational weeks, 14; and tumor diameter, 7.7 cm. There were no significant differences between those of the laparoscopy group and the laparotomy group. The average surgery time in the laparoscopy group (96 minutes) was longer than that of the laparotomy group (46 minutes). The advantages for patients in the laparoscopy group were significant reduction in average blood loss (10 ml) and shorter average hospital stay (4.8 days). Spontaneous abortion and preterm labor occurred in two cases (one abortion at 17 weeks' gestation and one preterm labor at 36 weeks' gestation) in the laparoscopy group and in one case in laparotomy group (preterm labor at 35 weeks' gestation). The abortion and preterm labor rate in the laparoscopy group (28.5%) was not significantly different than that of the laparotomy group (8.3%). Conclusions: Our study suggests that laparoscopy for adnexal mass in pregnancy is effective and feasible as a minimally invasive procedure. It is necessary to accumulate further data before we can confirm the safety and efficacy of laparoscopy in pregnancy.

妊娠に合併した付属器腫瘍に対する腹腔鏡手術の検討

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