В статье проведен сравнительный анализ использования лапароскопического и лапаротомного доступа в лечении опухолей и опухолевидных образований яичников у 123 беременных. Доказаны высокая эффективность и безопасность лапароскопии в I и первой половине II триместра беременности за счет меньшей продолжительности самой операции, послеоперационного периода и периода госпитализации, меньшей кровопотери и потребности в использовании анальгетиков, при сходной эффективности хирургического лечения и меньшем риске преждевременных родов. Ключевые слова: беременность, опухоли и опухолевидные образования яичников, лапароскопия, лапаротомия, осложнения, преждевременные роды.
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A comparative analysis of 123 pregnant women who underwent laparotomy or laparoscopy surgery for adnexal masses was performed. Laparoscopy has obvious benefits in pregnancy because of decreased postoperative pain, less narcotic use, shorter hospital stays and faster postoperative return to regular activity. First and mid-second trimester of pregnancy seems to be the most appropriate period for laparoscopic surgery because of minimal risk of preterm labour.
1. Адамян Л.В., Мурашко Л.Е., Романова Е.Л. Хирургическое лечение опухолей и опухолевидных образований яичников у беременных с использованием современных технологий. Проблемы репродукции. 2005; 3: 60–4.
2. Ашрафян Л.А., Киселев В.И. Опухоли репродуктивной системы (этиология, патогенез). М.: Димитрейд График Групп, 2007.
3. Бахидзе Е.В. Опухоли яичника у беременных. Журн. акушерства и женских болезней. 2011; LX (3): 190–6.
4. Бахидзе Е.В., Чепик О.Ф., Гедерим М.Н., Максимов С.Я. Сохранение фертильности у больных начальным раком яичников. Рос. вестн. акушера-гинеколога. 2004; 1: 49–54.
5. Краснопольский В.И., Логутова Л.С., Попов А.А. и др. Лапароскопия в диагностике и лечении кист и доброкачественных опухолей яичников у беременных и родильниц. Рос. вестн. акушера-гинеколога. 2002; 6: 65–6.
6. Магнитская Н.А. Диагностика и лечение образований яичников у беременных. Автореф. дис. ... канд. мед. наук. М., 2012.
7. Новикова Е.Г., Шевчук А.С., Завалишина Л.Э. Некоторые аспекты органосохраняющего лечения пограничных опухолей яичников. Рос. онкол. журн. 2010; 4: 15–20.
8. Романова Е.Л. Современные подходы к хирургическому лечению беременных с опухолями и опухолевидными образованиями яичников. Автореф. дис. … канд. мед. наук. М., 2006.
9. Урманчеева А.Ф., Кутушева Г.Ф., Ульрих Е.А. Опухоли яичника (клиника, диагностика и лечение). СПб.: Н-Л, 2012.
10. Aggarwal P, Kehoe S. Ovarian tumors in pregnancy: a literature review. Eur J Obstet Gynecol Reprod Biol 2011; 155: 119–24.
11. Al-Fozan H, Tulandi T. Safety and risks of laparoscopy in pregnancy. Curr Opin Obstet Gynecol 2002; 14: 375–9.
12. Balci O, Gezginc K, Karatayli R et al. Management and outcomes of adnexal masses during pregnancy: a 6-year experience. J Obstet Gynaecol Res 2008; 34 (4): 524–8.
13. Barnard JL, Chaffin D, Droste S et al. Fetal response to carbon dioxide pneumoperitoneum the pregnant ewe. Obstet Gynecol 1995; 85: 669–74.
14. Behtash N, Karimi Zarchi M, Modares Gilani M et al. Ovarian carcinoma associated with pregnancy: a clinicopathologic analysis of 23 cases and review of the literature. BMC Pregnancy Childbirth 2008; 8: 3–10.
15. Fatum M, Rojansky N. Laparoscopic surgery during pregnancy. Obstet Gynecol Survey 2001; 56: 50–9.
16. Ferrandina G, Distefano M, Testa A et al. Management of an advanced ovarian cancer at 15 weeks of gestation: case report and literature review. Gynecol Oncol 2005; 97: 693–6.
17. Hoover K, Jenkins TR. Evaluation and management of adnexal mass in pregnancy. Am J Obstet Gynecol 2011; p. 97–102.
18. Koo YJ, Kim HJ, Lim KT et al. Laparotomy versus laparoscopy for the treatment of adnexal masses during pregnancy. Aust N Z J Obstet Gynaecol 2012; 52: 34.
19. Kumari I, Kaur S, Mohan H, Huria A. Adnexal masses in pregnancy: a 5-year review. Aust N Z J Obstet Gynaecol 2006; 46: 52–4.
20. Lee D, Abraham N. Laparoscopic radical nephrectomy during pregnancy: case report and review of the literature. J Endourol 2008; 22: 517.
21. Lee YY, Kim TJ, Choi CH et al. Factors influencing the choice of laparoscopy or laparotomy in pregnant women with presumptive benign ovarian tumours. Int J Gynaecol Obstet 2010; 108 (1): 12–5.
22. Leiserowitz G, Xing G et al. Adnexal masses in pregnancy: how often are they malignant? Gynecol Oncol 2006; 101: 315–21.
23. Leiserowitz GS. Managing ovarian masses during pregnancy. Obstet Gynecol Surv 2006; 61 (7): 463–70.
24. Marret H, Lhomme C, Lecuru F et al. Guidelines for the management of ovarian cancer during pregnancy. Eur J Obstet Gynecol Reprod Biol 2010; 149: 18–21.
25. Maurizio B, Edgardo S, Silvia O et al. Decidualized ovarian endometriosis in pregnancy: a challenging diagnostic entity. Hum Reprod 2009; 24: 1818–24.
26. Mazze R, Kallen B. Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol 1989; 161: 1178–85.
27. Mhuireachtaigh RN, O’Gorman DA. Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth 2006; 18: 60–6.
28. Norwitz ER, Park JS, Snegovskikh D et al. Management of pregnant women undergoing nonobstetric surgery. URL: http://www.uptodate.com/contents/
29. Oelsner G, Stockheim D, Soriano D et al. Pregnancy outcome after laparoscopy or laparotomy in pregnancy. J Am Assoc Gynecol Laparosc 2003; 10: 200–4.
30. Reedy MB, Källén B, Kuehl TJ. Laparoscopy during pregnancy: a study of five outcome parameters with use of the Swedish Health Registry. Am J Obstet Gynecol 1997; 177: 673–9.
31. Reynolds JD, Booth JB, de la Fuente S et al. A review of laparoscopy for non-obstetric related surgery during pregnancy. Curr Surg 2003; 60: 164–73.
32. Rizzo AG. Laparoscopic surgery in pregnancy: long-term follow-up. J Laparoendosc Adv Surg Tech 2003; 13 (1): 11–5.
33. Roman H, Accoceberry M, Bolandard F et al. Laparoscopic management of a ruptured benign dermoid cyst during advanced pregnancy. J Minim Invasive Gynecol 2005; 12: 377.
34. Runowicz CD, Brewer M, Goff B, Barss VA. Management of ovarian cancer in pregnant women. URL: http://www.uptodate.com/contents/
35. SAGES Guidelines Committee. Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc 2008; 22: 849–61.
36. Schmeler KM, Mayo-Smith WW, Peipert JF et al. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol 2005; 105: 1098–103.
37. Sherard GB, Hodson CA et al. Adnexal masses and pregnancy: a 12-year experience. Am J Obstet Gynecol 2003; 189: 358–62.
38. Soriano D, Yefet Y et al. Laparoscopy versus laparotomy in the management of adnexal masses during pregnancy. Fertil Steril 1999; 71: 955–60.
39. Stany MP, Elkas JC, Ramin SM et al. Laparoscopic surgery in pregnancy. URL: http://www.uptodate.com/contents
40. Stepp K, Falcone T. Laparoscopy in the second trimester of pregnancy. Obstet Gynecol Clin N Am 2004; 31: 485–96.
41. Upadhyay A, Stanten S, Kazantsev G et al. Laparoscopic management of a nonobstetric emergency in the third trimester of pregnancy. Surg Endosc 2007; 21: 1344.
42. Wai PY, Ruby JA, Davis KA et al. Laparoscopic ventral hernia repair during pregnancy. Hernia 2009; 13: 559.
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1. Адамян Л.В., Мурашко Л.Е., Романова Е.Л. Хирургическое лечение опухолей и опухолевидных образований яичников у беременных с использованием современных технологий. Проблемы репродукции. 2005; 3: 60–4.
2. Ашрафян Л.А., Киселев В.И. Опухоли репродуктивной системы (этиология, патогенез). М.: Димитрейд График Групп, 2007.
3. Бахидзе Е.В. Опухоли яичника у беременных. Журн. акушерства и женских болезней. 2011; LX (3): 190–6.
4. Бахидзе Е.В., Чепик О.Ф., Гедерим М.Н., Максимов С.Я. Сохранение фертильности у больных начальным раком яичников. Рос. вестн. акушера-гинеколога. 2004; 1: 49–54.
5. Краснопольский В.И., Логутова Л.С., Попов А.А. и др. Лапароскопия в диагностике и лечении кист и доброкачественных опухолей яичников у беременных и родильниц. Рос. вестн. акушера-гинеколога. 2002; 6: 65–6.
6. Магнитская Н.А. Диагностика и лечение образований яичников у беременных. Автореф. дис. ... канд. мед. наук. М., 2012.
7. Новикова Е.Г., Шевчук А.С., Завалишина Л.Э. Некоторые аспекты органосохраняющего лечения пограничных опухолей яичников. Рос. онкол. журн. 2010; 4: 15–20.
8. Романова Е.Л. Современные подходы к хирургическому лечению беременных с опухолями и опухолевидными образованиями яичников. Автореф. дис. … канд. мед. наук. М., 2006.
9. Урманчеева А.Ф., Кутушева Г.Ф., Ульрих Е.А. Опухоли яичника (клиника, диагностика и лечение). СПб.: Н-Л, 2012.
10. Aggarwal P, Kehoe S. Ovarian tumors in pregnancy: a literature review. Eur J Obstet Gynecol Reprod Biol 2011; 155: 119–24.
11. Al-Fozan H, Tulandi T. Safety and risks of laparoscopy in pregnancy. Curr Opin Obstet Gynecol 2002; 14: 375–9.
12. Balci O, Gezginc K, Karatayli R et al. Management and outcomes of adnexal masses during pregnancy: a 6-year experience. J Obstet Gynaecol Res 2008; 34 (4): 524–8.
13. Barnard JL, Chaffin D, Droste S et al. Fetal response to carbon dioxide pneumoperitoneum the pregnant ewe. Obstet Gynecol 1995; 85: 669–74.
14. Behtash N, Karimi Zarchi M, Modares Gilani M et al. Ovarian carcinoma associated with pregnancy: a clinicopathologic analysis of 23 cases and review of the literature. BMC Pregnancy Childbirth 2008; 8: 3–10.
15. Fatum M, Rojansky N. Laparoscopic surgery during pregnancy. Obstet Gynecol Survey 2001; 56: 50–9.
16. Ferrandina G, Distefano M, Testa A et al. Management of an advanced ovarian cancer at 15 weeks of gestation: case report and literature review. Gynecol Oncol 2005; 97: 693–6.
17. Hoover K, Jenkins TR. Evaluation and management of adnexal mass in pregnancy. Am J Obstet Gynecol 2011; p. 97–102.
18. Koo YJ, Kim HJ, Lim KT et al. Laparotomy versus laparoscopy for the treatment of adnexal masses during pregnancy. Aust N Z J Obstet Gynaecol 2012; 52: 34.
19. Kumari I, Kaur S, Mohan H, Huria A. Adnexal masses in pregnancy: a 5-year review. Aust N Z J Obstet Gynaecol 2006; 46: 52–4.
20. Lee D, Abraham N. Laparoscopic radical nephrectomy during pregnancy: case report and review of the literature. J Endourol 2008; 22: 517.
21. Lee YY, Kim TJ, Choi CH et al. Factors influencing the choice of laparoscopy or laparotomy in pregnant women with presumptive benign ovarian tumours. Int J Gynaecol Obstet 2010; 108 (1): 12–5.
22. Leiserowitz G, Xing G et al. Adnexal masses in pregnancy: how often are they malignant? Gynecol Oncol 2006; 101: 315–21.
23. Leiserowitz GS. Managing ovarian masses during pregnancy. Obstet Gynecol Surv 2006; 61 (7): 463–70.
24. Marret H, Lhomme C, Lecuru F et al. Guidelines for the management of ovarian cancer during pregnancy. Eur J Obstet Gynecol Reprod Biol 2010; 149: 18–21.
25. Maurizio B, Edgardo S, Silvia O et al. Decidualized ovarian endometriosis in pregnancy: a challenging diagnostic entity. Hum Reprod 2009; 24: 1818–24.
26. Mazze R, Kallen B. Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol 1989; 161: 1178–85.
27. Mhuireachtaigh RN, O’Gorman DA. Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth 2006; 18: 60–6.
28. Norwitz ER, Park JS, Snegovskikh D et al. Management of pregnant women undergoing nonobstetric surgery. URL: http://www.uptodate.com/contents/
29. Oelsner G, Stockheim D, Soriano D et al. Pregnancy outcome after laparoscopy or laparotomy in pregnancy. J Am Assoc Gynecol Laparosc 2003; 10: 200–4.
30. Reedy MB, Källén B, Kuehl TJ. Laparoscopy during pregnancy: a study of five outcome parameters with use of the Swedish Health Registry. Am J Obstet Gynecol 1997; 177: 673–9.
31. Reynolds JD, Booth JB, de la Fuente S et al. A review of laparoscopy for non-obstetric related surgery during pregnancy. Curr Surg 2003; 60: 164–73.
32. Rizzo AG. Laparoscopic surgery in pregnancy: long-term follow-up. J Laparoendosc Adv Surg Tech 2003; 13 (1): 11–5.
33. Roman H, Accoceberry M, Bolandard F et al. Laparoscopic management of a ruptured benign dermoid cyst during advanced pregnancy. J Minim Invasive Gynecol 2005; 12: 377.
34. Runowicz CD, Brewer M, Goff B, Barss VA. Management of ovarian cancer in pregnant women. URL: http://www.uptodate.com/contents/
35. SAGES Guidelines Committee. Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc 2008; 22: 849–61.
36. Schmeler KM, Mayo-Smith WW, Peipert JF et al. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol 2005; 105: 1098–103.
37. Sherard GB, Hodson CA et al. Adnexal masses and pregnancy: a 12-year experience. Am J Obstet Gynecol 2003; 189: 358–62.
38. Soriano D, Yefet Y et al. Laparoscopy versus laparotomy in the management of adnexal masses during pregnancy. Fertil Steril 1999; 71: 955–60.
39. Stany MP, Elkas JC, Ramin SM et al. Laparoscopic surgery in pregnancy. URL: http://www.uptodate.com/contents
40. Stepp K, Falcone T. Laparoscopy in the second trimester of pregnancy. Obstet Gynecol Clin N Am 2004; 31: 485–96.
41. Upadhyay A, Stanten S, Kazantsev G et al. Laparoscopic management of a nonobstetric emergency in the third trimester of pregnancy. Surg Endosc 2007; 21: 1344.
42. Wai PY, Ruby JA, Davis KA et al. Laparoscopic ventral hernia repair during pregnancy. Hernia 2009; 13: 559.
1. ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздрава России, Москва;
2. ФГБУ Российский онкологический научный центр им. Н.Н.Блохина РАМН, Москва