输卵管妊娠的临床诊治分析

目的 探讨输卵管妊娠的临床特点和诊治方法.方法 回顾性分析287例输卵管妊娠患者的临床资料,包括常规化验、超声检查及腹腔镜手术资料.分析临床特点和手术指标.采用传统开腹手术和腹腔镜手术,其中腹腔镜手术193例(腹腔镜手术组),传统开腹手术94例(传统开腹手术组).结果 (1)输卵管妊娠患者临床表现以腹痛、停经和阴道不规则流血为主,分别为287例(100％)、232例(80.8％)和179例(62.4％).(2)超声检查发现包块257例(89.5％),盆腔积液167例(58.2％),附件区有胚囊或胚囊样结构32例(11.1％),有胚芽或胎心19例(6.6％).尿妊娠试验阳性248例,阳性率为86.4％,血绒毛膜促性腺激素(β-HCG)平均为(545.0±231.6) U/L.(3)既往史:有结扎手术史及其他避孕史34例(11.8％),外科手术史43例(15.0％),人工流产史87例(30.3％),肝炎、疟疾、结核病史33例(11.5％).(4)287例手术均成功,平均手术时间(44.5±6.7)min,住院时间(4.1±2.7)d,无术后并发症发生,腹部伤口均一期愈合.术后24h血 β-HCG下降均≥50％.腹腔镜手术组和传统开腹手术组分别有26例和43例需要输血.2组的肛门排气时间、下床活动时间、住院时间、发热例数和镇痛例数腹腔镜手术组均明显优于传统开腹手术组,差异均有统计学意义(t值分别为5.27、4.82、3.72,x2值分别为5.53、14.29；P＜0.01,P＜0.05),但手术时间比较差异无统计学意义(P＞0.05).结论 腹痛、停经和阴道流血是输卵管妊娠最常见的临床表现；血β-HCG联合超声检查是目前诊断异位妊娠的最佳方案；腹腔镜手术创伤小,是输卵管妊娠诊治的最好方式.

Diagnosis and treatment of tubal pregnancy

Objective To explore the clinical features of tubal pregnancy and summarize the diagnosis and treatment.Methods The clinical data of 287 cases were reviewed including routine test,ultrasound examination,and laparoscopic surgery.The clinical features and indicators of surgery were evaluated,193 cases treated by laparoscopic surgery and 94 cases treated by traditional surgery.Results ( 1 ) The major clinical manifestations of tubal pregnancy were abdominal pain ( 100％ ),menopause ( 80.8％ ) and irregular vaginal bleeding (62.4％).(2) By ultrasound examination mass was found in 257 cases (89.5％ ),and pelvic cavity accumulates liquid in 167 cases (58.2％ ).In accessories division 32 cases ( 11.1％ ) had blastocyst and 19 cases (6.6％ ) had embryo or fetal heart.The positive rate of urine pregnancy test was 86.4％,and the average level of blood 3-HCG was (545.0 ± 231.6) U/L.( 3 ) The past medical history was as follows:Tirty-four cases ( 11.8％ ) with ligation or other method of contraception,43 cases ( 15.0％ ) with surgery,87 cases (30.3％ )with artiflcal abortion,and 33 cases ( 11.5％ ) with hepatitis,malaria or tuberculosis.(4)All the surgery succeed with an average surgery time of (44.5 ± 6.7 ) min.Ninety-seven cases were treated with blood transfusion and there were no complications.Operative wound of all patients were healed first term,and the time stay in hospital was (4.1 ± 2.7 ) d,and the levels of blood β-HCG all dropped ≥50％ by 24 h after surgery.Conclusion ( 1 ) Abdominal pain,menopause,and irregular vaginal bleeding are the major clinical manifestations of tubal pregnancy.(2)The best method of diagnosis in tubal pregnancy is blood β-HCG and ultrasound examination.(3) Laparoscopic gynaecological surgery has such merits as minimal invasion,and it is the best way for diagnosis and treatment of tubal pregnancy.