[申覆] 醫學五 7

[surgeoner (小刀)]

下列何者是腹腔鏡膽囊切除術（laparoscopic cholecystectomy）的 major
contraindication？
猨(A)懷孕婦女    獏(B)Calot’s triangle 無法清楚辨識
獱(C)腹部曾開過刀     (D)肝硬化病人

答案: B
建議答案: A或B

申覆理由:
孕婦在1st trimester動laparoscopic cholecystectomy會有畸胎跟自然流產的風險, 另
外3rd trimester則會增加preterm labor, premature delivery風險. 因此孕婦應該等到
2nd trimester或到小孩生出來以後才開刀比較適合.
因此孕婦如果在1st和3rd trimester的話也不應該開laparoscopic cholecystectomy.
ps: 很遺憾在Schwartz和Sabiston都沒找到相關敘述
    而考選部公布的外科參考書還有
    Textbook of Surgery：the biological basis of modern surgical practice,(17th
    ed.) , by David C.  Sabiston(ed.) W. B. Saunders Co (2004)
    不知道有沒有好心人有這本或有電子檔, 幫忙看一下補充一下  感恩

參考資料：
http://www.laparoendoscopy.com/lap_chole.htm


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推 lepputte:Sabiston17th p1612 Cholecystectomy:indications...
→ lepputte:Few current contraindication to LC = uncontrolled
→ lepputte:coagulopathy, severe COPD/CHF 第二欄則提到 major
→ lepputte:contraindication is inability to clearly identify
→ lepputte:all structure.
推 lepputte:Johns Hopkins manual of GYN-OBS 4th p251 LC may be
→ lepputte:performed in all trimesters, 但如可以 LC安排在2nd
→ lepputte:trimester為佳.  懷孕應該不是LC的major禁忌症
推 lepputte:此題申覆 難過....
→ surgeoner:恩, 謝謝, 我看兩本大書都沒寫, 就覺得有危險了 ~"~
→ surgeoner:不過還是拚拚看吧 sigh
推 lepputte:如果要拼 找找看 William產科 大書  孕中手術一節 看有沒
→ lepputte:有提到 LC 禁忌  試試看