[申覆] 醫學五 7
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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