腹腔镜治疗异位妊娠85例临床分析(1)
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【中图分类号】R714.22 【文献标识码】A 【文章编号】1672-6383(2010)11-0017-02
【摘要】目的:探讨电视腹腔镜治疗异位妊娠的安全性、优越性。方法:回顾2008.1-2010.6我院收治的异位妊娠患者,其中85例采用腹腔镜治疗,与同期45例开腹手术相比较,根据妊娠部位及患者有无生育要求及盆腔具体情况,采用不同手术方式。结果:85例腹腔镜手术均获成功,无一例中转开腹。两组病人在年龄、腹部手术史、慢性盆腔炎史,无明显差异;比较两组手术时间、术中出血量、术后排气时间、术后镇痛时间及住院时间,两组有显著差异。结论:腹腔镜治疗异位妊娠是一种理想手术方式,是安全的,且不需要进腹,腹部无疤痕,术后粘连少,对需要以后多次手术的尤为适用。
【关键词】 腹腔镜手术;异位妊娠;微创
Laparoscopic treatment of ectopic pregnancy clinical analysis of 85 cases
He Lingzhi
【Abstract】 Objective: To evaluate the laparoscopic treatment of ectopic pregnancy safety, superiority. Methods: 2008.1-2010.6 ectopic pregnancy in our hospital patients, 85 were treated with laparoscopic surgery, with the same period 45 cases of open surgery compared to patients according to location and availability of fertility pregnancy and pelvic specific conditions required by different surgical way. Results: 85 patients undergoing laparoscopic surgery were successful, with no conversion to open surgery. Two groups in age, abdominal surgery, history of chronic pelvic inflammatory disease, no significant difference; compared two groups of operating time, blood loss, postoperative discharge time, postoperative pain and hospital stay, the two groups were significantly different . Conclusion: Laparoscopic treatment of ectopic pregnancy is an ideal surgical procedure is safe and does not need into the abdomen, abdominal no scars, less postoperative adhesions, the need for repeated surgery, especially for the future.
【Key words】 Laparoscopic surgery; Ectopic pregnancy; Minimally invasive
异位妊娠是妇科常见病,起病急,发展快,如不及时救治,容易导致严重后果,甚至危及生命。由于目前诊断技术的提高,动态监测血β-HCG、阴道彩色超声等,对异位妊娠早期诊断起到很大的作用,及时采用腹腔镜检查及手术,既能做到早日确诊,解除大出血的风险,又能做到微创、不留疤痕。我院于2008.1~2010.6间收治的异位妊娠病人,其中85例采用腹腔镜手术,与同期45例开腹手术相比较,取得满意效果。现报道如下:
1. 资料与方法
1.1 一般资料:
腹腔镜组85例,年龄19~45岁,平均年龄31.26岁。其中经产妇69例,未产妇16例,多次人流史30例,留置IUD史26例,腹部手术史22例(剖宫产8例,双侧输卵管结扎术6例,异位妊娠3例,阑尾手术2例,卵巢巧克力囊肿剥除术3例),既往有慢性盆腔炎病史26例,有停经史80例,阴道不规则流血85例,B超提示附件包块40例,尿HCG阳性或血β-HCG增高85例,后穹窿穿刺不凝血62例。开腹组45例,年龄20~43岁,平均31.12岁,经产妇40例,未产妇5例,多次人流史13例,腹部手术史8例(剖宫产5例,输卵管结扎术2例,腹腔镜下盆腔粘连松解术1例),停经史40例,不规则流血史45例,盆腔炎病史18例。经统计学检验,两组术前情况差异无显著性(p>0.05)。具体比较见表1。
表1 两组术前一般情况比较
组别年龄(y)停经史(n)多次人流史(n)腹部手术史(n)盆腔炎史(n)
1.2 手术方法:85例腹腔镜组患者均采用气管插管静脉全身复合麻醉,术中持续心电监护及血氧饱和度监测,取头低脚高仰卧位。45例开腹组采用联合腰麻+连续硬膜外麻醉,术中心电监护,取平卧位 ......
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