腹腔鏡手術治療異位妊娠108例臨床分析

何 菁

[摘要] 目的 探討腹腔鏡手術治療異位妊娠手術方法及手術注意事項。方法 對2007年1月-2008年12月腹腔鏡手術異位妊娠108例患者進行回顧性分析。結果 108例中103例成功行腹腔鏡手術,有生育要求患者均保留輸卵管,3例手術困難中轉開腹,2例術后7天、14天再次行開腹手術。結論 腹腔鏡下異位妊娠手術對患者創傷小、恢復快,成為臨床首選手術方式,但注意病例選擇及手術方式并盡量避免持續性異位妊娠的發生。

[關鍵詞] 腹腔鏡;異位妊娠;治療學

[中圖分類號] R714.22[文獻標識碼] A [文章編號] 1004-8650(2009)05-035-03

[Abstract] Objective To study the surgery methods and cautionary measures in treating extra-uterine pregnancy with laparoscopy. Methods Retrospective analysis is undertaken to 108 cases with extra-uterine pregnancy treated with laparoscopy from January 2007 to December 2008. Results 103 of the 108 cases were successfully undertaken surgery with laparoscopy. Patients who intended procreation were preserved their oviducts. 3 cases encountered difficult surgery had transferred to open venter surgery. 2 cases received a second open venter surgery 7days and 14 days after surgery. Conclusion Surgery to patients with extra-uterine pregnancy by laparoscopy caused very little injury, and achieved rapid recovery. It becomes the first clinical option in surgery. Cases selection and surgery methods shall be paid attention to avoid durative extra-uterine pregnancy occurring.

[Key words] Laparoscopy; Extra-uterine pregnancy; Therapeutics

異位妊娠是嚴重危害婦女生命和健康的常見病,近年來發病率有明顯增高的趨勢[1]。國內由1:162上升為1:56-93[2]。腹腔鏡手術應用于異位妊娠的診斷和治療具有準確性高、治療及時的特點。國外學者報道腹腔鏡診斷的準確性達99%以上[3]。現將我院腹腔鏡下異位妊娠治療108例報道如下。

1材料與方法

1.1一般資料

收集我院2007年1月-2008年12月間共有異位妊娠145例,行電視腹腔鏡手術108例。年齡17-39歲,61例未產婦,47例經產婦,37例曾人流1-3次,61例藥流1-2次,腹部手術史33例,其中第2次異位妊娠9例,不孕癥43例。

94例有停經史,時間32-82天,腹痛及不規則陰道出血82例,所有病例均有尿妊娠試驗陽性或血HCG升高,B超檢查宮腔內無妊娠囊。93例盆腔液性暗區,行穹隆穿刺抽出不凝血,87例宮旁有混合性包塊,所有病例均不并發失血性休克,15例診刮術,未見絨毛。

1.2方法

應用德國Roudilf公司生產的腹腔鏡及配套手術器械,108例全部采用連續硬膜外麻醉和靜脈復合麻醉,除臍部穿刺外,另取兩個下腹部麥氏點穿刺點進行操作。……