多次腹腔手术史合并克罗恩病患者的腹膜外剖宫产:一例病例报告
Cesarean Delivery After Multiple Prior Intraperitoneal Surgeries: A Case Report in a Patient With Crohn Disease
摘要
本文报告一例25岁克罗恩病(处于持续临床缓解)女性,既往接受5次腹腔内手术(双侧半结肠切除、结肠造口、阑尾切除及粘连松解),经体外受精妊娠且孕期平顺。因预计腹腔广泛粘连,于孕37周在加速康复(ERAC)路径下施行腹膜外French Ambulatory剖宫产(FAUCS),娩出一健康男婴(2550 g,5分钟Apgar 10分),术后恢复顺利、无并发症。作者强调该技术在此类复杂手术史患者中可行,但系单例经验,不构成安全性或有效性结论。
原文摘要
BACKGROUND The mode of delivery in women with inflammatory bowel disease (IBD), including Crohn disease, requires individualized multidisciplinary assessment. Prior abdominal surgery increases the risk of intra-abdominal adhesions and operative complications. The extraperitoneal French Ambulatory Cesarean Section (FAUCS) technique may help avoid peritoneal entry in selected patients with complex surgical histories. This report describes the feasibility and short-term perioperative outcome of FAUCS in a patient with multiple prior intraperitoneal surgeries. Crohn disease is presented as a relevant comorbidity rather than the primary operative indication. CASE REPORT We report the case of a 25-year-old woman with Crohn disease and a history of 5 prior intraperitoneal surgical procedures, including bilateral hemicolectomy, colostomy formation, appendectomy, and adhesiolysis. The pregnancy was achieved through in vitro fertilization and remained uncomplicated, with Crohn disease in sustained clinical remission. No preoperative imaging was performed; the likelihood of adhesions was inferred from multiple laparotomies and previous adhesiolysis. Due to anticipated extensive intra-abdominal adhesions, elective cesarean delivery using the extraperitoneal FAUCS technique was performed under an enhanced recovery after cesarean (ERAC) pathway. A healthy male neonate was delivered at 37 weeks of gestation, weighing 2550 g (Apgar score 10 at 5 minutes). Postoperative recovery was uncomplicated, with early oral intake, mobilization, minimal analgesic requirements, and no postoperative complications. CONCLUSIONS This case documents the feasibility and perioperative outcomes of extraperitoneal FAUCS in a rare scenario involving multiple prior intraperitoneal surgeries and Crohn disease in remission. It is intended to support clinician awareness and case-based learning rather than establish safety or efficacy claims.
推荐理由:单例病例报告,为有多次腹腔手术史的IVF妊娠者提供腹膜外剖宫产这一术式选择的初步围产期经验;但证据等级低、未做术前影像评估,且属产科手术学范畴,对ART核心实践的推动有限,可作浏览。
文献解读
尚未生成。