作者surgeoner (小刀)
看板medstudent
标题[申覆] 医学五 7
时间Tue Feb 22 21:24:12 2011
下列何者是腹腔镜胆囊切除术（laparoscopic cholecystectomy）的 major
contraindication？
猨(A)怀孕妇女 獏(B)Calot’s triangle 无法清楚辨识
獱(C)腹部曾开过刀 (D)肝硬化病人
答案: B
建议答案: A或B
申覆理由:
孕妇在1st trimester动laparoscopic cholecystectomy会有畸胎跟自然流产的风险, 另
外3rd trimester则会增加preterm labor, premature delivery风险. 因此孕妇应该等到
2nd trimester或到小孩生出来以後才开刀比较适合.
因此孕妇如果在1st和3rd trimester的话也不应该开laparoscopic cholecystectomy.
ps: 很遗憾在Schwartz和Sabiston都没找到相关叙述
而考选部公布的外科参考书还有
Textbook of Surgery：the biological basis of modern surgical practice,(17th
ed.) , by David C. Sabiston(ed.) W. B. Saunders Co (2004)
不知道有没有好心人有这本或有电子档, 帮忙看一下补充一下 感恩
参考资料：
http://www.laparoendoscopy.com/lap_chole.htm
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1F：推 lepputte:Sabiston17th p1612 Cholecystectomy:indications... 02/23 00:49
2F：→ lepputte:Few current contraindication to LC = uncontrolled 02/23 00:51
3F：→ lepputte:coagulopathy, severe COPD/CHF 第二栏则提到 major 02/23 00:52
4F：→ lepputte:contraindication is inability to clearly identify 02/23 00:53
5F：→ lepputte:all structure. 02/23 00:55
6F：推 lepputte:Johns Hopkins manual of GYN-OBS 4th p251 LC may be 02/23 01:00
7F：→ lepputte:performed in all trimesters, 但如可以 LC安排在2nd 02/23 01:01
8F：→ lepputte:trimester为佳. 怀孕应该不是LC的major禁忌症 02/23 01:02
9F：推 lepputte:此题申覆 难过.... 02/23 01:17
10F：→ surgeoner:恩, 谢谢, 我看两本大书都没写, 就觉得有危险了 ~"~ 02/23 08:25
11F：→ surgeoner:不过还是拚拚看吧 sigh 02/23 08:26
12F：推 lepputte:如果要拼 找找看 William产科 大书 孕中手术一节 看有没 02/23 10:00
13F：→ lepputte:有提到 LC 禁忌 试试看 02/23 10:01