宫内外复合妊娠腹腔镜手术治疗34例分析

目的:探讨宫内外复合妊娠(HP)腹腔镜治疗的有效性、安全性及对妊娠结局的影响。方法:回顾性分析2011年1月—2018年1月天津市中心妇产科医院收治的宫内妊娠合并输卵管妊娠共34例,探讨腹腔镜手术治疗的可行性和妊娠结局。结果:34例患者均为宫内妊娠合并单侧输卵管妊娠,其中特殊病例包括:宫内双胎妊娠合并右侧输卵管妊娠1例,宫内妊娠合并右侧输卵管间质部妊娠1例,双子宫右侧宫腔妊娠合并左侧输卵管妊娠1例。所有患者均行腹腔镜手术治疗,手术时间15～110 min,平均(45.21±8.33)min;术中出血5～200 m L,平均(33.04±10.12)m L,其中3例因术前腹腔出血超过800 mL行输血治疗。术后患者无发热、切口感染和术后并发症,超声检查提示宫内妊娠状态正常,患者恢复良好。除胚胎停育行人工流产1例和失访1例外,余33例新生儿(1例双胎妊娠分娩)均为活产,未见新生儿发育畸形。结论:对于妊娠早期的宫内妊娠合并单侧输卵管妊娠患者,腹腔镜手术去除输卵管异位妊娠安全有效,术后未增加医源性流产率及新生儿出生缺陷发生率。

Analysis of the Feasibility and Outcome of Laparoscopic Treatment of Hetertopic Pregnancy

Objective：To explore the feasibility, safety of laparoscopic treatment of hetertopic pregnancy (HP) and the effect on the outcome of pregnancy. Methods：34 HP patients with tubal pregnancy admitted to our hospital from January 2011 to January 2018 were selected for retrospective analysis, to explore the high-risk factors of hetertopic pregnancy, the feasibility of laparoscopic surgery and the pregnancy outcome. Results：There were 34 cases. Special cases included: 1 case of intrauterine twin pregnancy with right tubal pregnancy, 1 case of intrauterine pregnancy with right tubal interstitial pregnancy, and 1 case of intrauterine twin right uterine pregnancy with left tubal pregnancy. All the patients were treated with laparoscopic surgery and recovered well after surgery, operation time was 15-110 minutes, (45.21±8.33) min on average. Intraoperative hemorrhage was 5-200 mL, with an average was (33.04±10.12) mL. 3 cases with preoperative intraperitoneal hemorrhage more than 800 mL were treated with blood transfusion therapy in the operations. No fever, incision infection or complications were observed. Ultrasound suggest intrauterine pregnancy is normal after the operation for each patient and all patient recovered well. Only one case of artificial abortion was performed with missed abortion. All the rest has live births without birth defects. Conclusions：For patients with intrauterine pregnancy with unilateral tubal pregnancy during first trimester, laparoscopic surgery can safely remove ectopic pregnancy in the fallopian tube, and the operation is safe and effective, without increasing the incidence of iatrogenic abortion and birth defects.