腹腔镜下输卵管切开取胚联合输卵管通液术对远期妊娠的影响

目的 探讨异位妊娠患者腹腔镜下行输卵管切开取胚术联合输卵管通液术对远期妊娠结局的影响。方法 选择2015年1月~2016年7月在我院妇科治疗的输卵管妊娠患者138例,依据手术方式不同分为实验组70例和对照组68例,实验组行腹腔镜下患侧输卵管切开取胚术及子宫输卵管通液术,对照组单纯行患侧输卵管切开取胚术,比较两组手术时间、术中出血量、术后排气时间、住院天数,及术后2年内妊娠情况。结果 两组患者术中出血量,手术时间、术后排气时间、住院天数比较,差异无统计学意义（P＞0.05）。实验组术后2年内再次异位妊娠率为4.23%,3例再次异位妊娠再次行腹腔镜手术,46例宫内妊娠,8例继发性不孕,6例失访。对照组的再次异位妊娠率为16.18%,11例再次异位妊娠再次行腹腔镜手术,30例宫内妊娠,13例继发性不孕,7例失访。实验组的再次异位妊娠率低于对照组,再次宫内妊娠率高于对照组,差异有统计学意义（P＜0.05）。结论 腹腔镜下切开取胚术联合输卵管通液术可同时在术中判断对健侧输卵管通畅度,还可指导通而不畅甚至堵塞输卵管术中同时治疗,可能有助于降低再次异位妊娠的概率。     

腹腔镜下输卵管线形切开术治疗输卵管妊娠的临床分析及手术技巧总结

目的总结腹腔镜下输卵管线形切开术治疗输卵管妊娠的各种手术技巧。方法回顾分析2008年1月~2011年1月间的56例行腹腔镜下输卵管线形切开术治疗输卵管妊娠的手术情况,观察平均住院日、手术时间、术中出血、术后再次出血、血绒毛膜促性腺激素(HCG)值下降、持续性异位妊娠、术后输卵管通液等情况。结果 56例手术均成功完成,无1例中转开腹和持续性异位妊娠。平均住院日4.3±0.7日,手术时间38.6±8.1min,术中出血35.3±8.6ml,术后引流量(24h)94.6±116.0ml,平均HCG降至正常时间10.8±2.3天,术后2个经期后输卵管通畅率82.1%。结论腹腔镜下线形切开术治疗输卵管妊娠准确有效,并更加微创。     

120例腹腔镜下输卵管妊娠切开术的配合体会

随着腔镜技术的不断进展，采用腹腔镜下输卵管妊娠切开取胎术成为常用方法。我院妇科自2005年7月至2008年8月对120例异位妊娠患者采用腹腔镜下输卵管切开取胎术，获得良好疗效。现将手术配合体会报告如下。     

腹腔镜在异位妊娠伴失血性休克治疗中的应用

目的 探讨异位妊娠伴有失血性休克患者行腹腔镜手术的可行性。方法 回顾性分析2000年5月至2005年3月在我院采用腹腔镜治疗输卵管妊娠211例患者，其中20例异位妊娠伴有失血性休克为研究组，余191例为对照组，分析两组患者固手术期情况。结果 研究组与对照组比较，年龄、孕次、手术时间、住院天数均元显著性差异，而腹腔内出血量及输卵管切除术，研究组显著高于对照组。结论 具有熟炼的腹腔镜操作技术，腹腔镜下治疗休克型异位妊娠是安全可行的。     

腹腔镜治疗异位妊娠62例临床分析

目的 探讨腹腔镜手术治疗异位妊娠的临床应用价值。方法 对62例患者均在入院后2h内完成术前准备，在气管插管全身麻醉下采用改良的三孔法置入腹腔镜器械，行输卵管开窗术56例，输卵管伞端取胚胎术6例。结果 所有手术均在腹腔镜下完成，平均手术时间52min，除2例脐部切口脂肪液化，余无并发症，手术成功率100％。发生并发症2例(3％)。结论 异位妊娠可用腹腔镜治疗。     

腹腔镜治疗306例异位妊娠的临床分析

目的 了解异位妊娠的临床特点,总结异位妊娠的相关病因学和腹腔镜术中所见特点,探讨腹腔镜手术在异位妊娠诊治中的可行性、安全性及治疗效果.方法 回顾性分析2007年6月～2009年6月在广西柳州市工人医院行腹腔镜手术治疗的306例异位妊娠患者的流行病学资料、手术方法和术中所见.结果 所有患者均接受了腹腔镜检查及治疗,其中腹腔镜下患侧输卵管切除术186例,占60.78%;保留输卵管手术(保守手术)120例,占39.22%.1例患者因腹腔粘连严重而中转开腹,余305例均成功经腹腔镜手术.腹腔镜手术术中发现异位妊娠不同比例地合并子宫内膜异位症、生殖器官畸形、盆腔结核、盆腔炎及手术后瘢痕粘连.术后无持续性异位妊娠,出血并发症发生率为0.83%.结论 异位妊娠发生率上升与人工流产、剖宫产率增高、盆腔感染、盆腔手术史、合并盆腔内膜异位症等高危因素有关.腹腔镜手术治疗妇科异位妊娠快速、安全、有效,故可作为一种常规手术加以推广.     

腹腔镜手术对输卵管妊娠患者术后生育结局的影响

目的探讨腹腔镜下不同术式对输卵管妊娠患者术后生育结局的影响。方法回顾分析了86例经腹腔镜手术及70例开腹手术的输卵管妊娠患者术后不孕、异位妊娠及宫内妊娠的发生率。结果经腹腔镜手术的患者术后宫内妊娠率50％高于行开腹手术者35．7％（P〈0.05）；在不同的腹腔镜术式中，行输卵管保守性手术的患者术后宫内妊娠率52．8％高于行患侧输卵管切除术者35．7％（P〈0.05）；在行保守性手术中，壶腹部妊娠及伞端妊娠患者术后宫内妊娠率分别为60％及61．1％，均高于峡部妊娠者31.6％（P〈0．05）。结论腹腔镜手术有利于改善输卵管妊娠患者术后生育结局，壶腹部妊娠及伞端妊娠患者宜行输卵管保守性手术。     

输卵管妊娠腹腔镜根治术后持续性异位妊娠原因分析及对策

目的 探讨输卵管妊娠腹腔镜根治术后持续性异位妊娠发生的原因,以寻求针对性的处理方法. 方法 回顾分析我院2007年1月至2009年1月670例输卵管妊娠患者行腹腔镜下输卵管切除术,术后发生持续性异位妊娠共6例.结果 4例采用药物保守治疗成功,2例保守治疗无效行手术治疗后成功.结论 在手术过程中尽量避免输卵管妊娠物直接经Troca钳夹取出,防止残留于Troca、勺状钳、冲洗棒头端等操作器械上的绒毛组织再次带入腹腔,可能有助于有效阻断持续性异位妊娠的形成.     

妇科腹腔镜手术560例临床分析

目的探讨腹腔镜手术式在妇科的临床应用价值。方法对560例腹腔镜手术进行回顾性分析:异位妊娠术式为输卵管切除术及输卵管切开取胚术;卵巢肿瘤手术采用剔除术、卵巢切除术及患侧附件切除术;子宫手术采用子宫肌瘤剔除术、CISH术、LAVH及LTH术。结果腹腔镜手术占同期妇科手术的62.9%,手术成功率99.28%,发生并发症4例(7.12%)。结论适应证掌握得当,妇科大部分手术可在腹腔镜下完成。     

急诊腹腔镜与传统开腹手术治疗输卵管异位妊娠疗效观察

目的：探讨急诊腹腔镜与传统开腹治疗输卵管异位妊娠的临床效果。方法选取2011年10月~2013年10月在我院接受输卵管异位妊娠治疗的患者64例为研究对象,随机分为观察组和对照组,每组32例患者,对观察组患者实施急诊腹腔镜手术治疗,对照组患者实施传统开腹手术治疗,观察两组患者的临床治疗效果。结果观察组患者手术时间、手术中出血量以及术后肛门排气时间和术后输卵管通畅率明显优于对照组,具有统计学意义(P<0.05)。结论在对输卵管异位妊娠患者实施治疗的过程中,急诊腹腔镜手术治疗可以缩短手术时间和肛门排气时间,减少手术过程中的出血量,提高输卵管通畅率,具有显著的效果,值得临床推广。     

Rare ectopic pregnancies after in-vitro fertilization: one unilateral twin and four bilateral tubal pregnancies

Between 1985 and 1989, one unilateral twin and four bilateral tubal pregnancies were encountered among 124 extrauterine pregnancies and 1648 intrauterine pregnancies following in-vitro fertilization and embryo transfer. The two factors associated with this high incidence of single and multiple extrauterine pregnancies were tubal damage and multiple embryo transfer. Embryos at different stages of development appear to have the capacity to implant ectopically. Despite advances in diagnostic capabilities, ectopic pregnancy remains a major cause of maternal mortality. Early diagnosis prior to rupture must be made if mortality and morbidity are to be abolished. The use of transvaginal sonography has improved the diagnosis of ectopic pregnancy and should be routinely used in all pregnancies following assisted conception. The identification of an intrauterine pregnancy should not be sufficient to rule out the possibility of an extrauterine pregnancy or even bilateral tubal pregnancies.     

Ovarian pregnancy

Ovarian pregnancy is a rare form of extrauterine pregnancy contributing < 3% of ectopic pregnancies. We report an ovarian pregnancy in a 23-year female.     

Primary peritoneal pregnancy implanted on the uterosacral ligament: a case report

Peritoneal pregnancies are classified as primary and secondary. Primary implantation on the peritoneum is extremely rare in extrauterine pregnancy and is a potentially life-threatening variation of ectopic pregnancy within the peritoneal cavity, representing a grave risk to maternal health. Secondary abdominal pregnancies are by far the most common and result from tubal abortion or rupture, or less often, after uterine rupture with subsequent implantation within abdomen. Early diagnosis and appropriate surgical management, regardless of stage of gestation, appear to be important in achieving good results. We report a case of primary peritoneal pregnancy in a 28-year-old woman, who had severe lower abdominal pain one day before laparotomy for a preoperative diagnosis of ectopic pregnancy. The conceptus was implanted on the left uterosacral ligament. A fresh embryo of approximately 8 weeks' gestation was found in the conceptus.     

卵巢妊娠24例回顾性临床分析

目的深入探讨卵巢妊娠的临床特征和诊治特点,进一步提高卵巢妊娠的术前诊断水平。方法回顾性分析我院2008年—2013年间24例确诊卵巢妊娠患者的临床资料。结果卵巢妊娠的临床表现与输卵管妊娠极为相似,有停经史、腹痛明显、后穹窿穿刺阳性,但无明显阴道流血史,均为卵巢妊娠破裂型。结论卵巢妊娠术前诊断率极低,需结合血HCG水平和B超检查,手术是主要确诊方法。     

Splenic pregnancy: a case report and review of the literature

Primary splenic pregnancy is the least common form of extrauterine pregnancy. We report a case of splenic pregnancy occurring in a 29-year-old woman presenting with acute abdomen and hemoperitoneum. Recognition of this rare form of gestation is of critical importance, owing to the risk of exsanguination and death, and should be considered in the differential diagnosis of acute abdomen in women of reproductive age.     

异位妊娠腹腔镜手术的临床研究

目的探讨腹腔镜手术治疗异位妊娠的临床应用价值.方法回顾分析我院2003年3月至2005年6月异位妊娠腹腔镜手术治疗86例的临床效果.结果本组年龄18～34岁,平均26岁,未婚32例,已婚54例,未产妇56例,经产妇30例.腹痛及阴道不规则出血62例.80例盆腔有液性暗区,后穹窿穿刺抽出不凝固血.腹腔镜手术成功,术中出血平均20 ml（10～60 ml）,手术时间平均为45 min（25～80 min）,术后住院平均3 d（2～5 d）,86例患者中无1例行第2次手术,月经于术后1～3个月恢复正常.结论异位妊娠腹腔镜手术安全可行,具有创伤小,疼痛轻,恢复快,并发症少等优点.     

经阴道穿刺治疗宫内外同时妊娠4例

目的 探讨经阴道穿刺在宫内外同时妊娠(HP)治疗中的应用及价值.方法 2004年1月至2009年12月广州医学院第三附属医院生殖医学中心体外授精-胚胎移植(IVF-ET)妊娠患者中,筛选出经阴道穿刺治疗的4例HP患者,分析探讨经阴道穿刺治疗HP的适应证、时机的选择、治疗方法及妊娠结局.结果 经阴道穿刺治疗的4例HP均为宫内妊娠合并输卵管妊娠,4例患者宫内妊娠胚胎及异位妊娠胚胎均见原始心管搏动.3例行经阴道穿刺抽吸异位妊娠胚胎,其中2例治疗时间分别为孕42d、43 d,均足月分娩,1例治疗时间为孕68d,穿刺术后4 h输卵管破裂行开腹手术治疗,术后4d宫内妊娠流产.另1例抽吸胚胎后注射50%葡萄糖2 ml,治疗时间为孕50 d,足月分娩.结论 如果HP患者孕周较小(＜8周),病变输卵管未破裂,无明显的腹腔内出血,术后能够有较长时间定期复诊随访,则可以选择经阴道穿刺治疗HP.     

A review of 254 ectopic pregnancies in a teaching hospital in the Trent Region, 1977-1990.

A total of 254 cases of ectopic pregnancy were reviewed in a teaching hospital in Sheffield, in three defined periods: I, 1977-9; II, 1985-7 and III, 1988-90. A previous history of infertility was noted in 37% of cases. Overall, the presenting symptoms, clinical, laboratory, operative as well as histological findings, are in broad agreement with other series. The incidence increased steadily from 8.6 per 1000 total births in period I to 16.5 per 1000 total births in period III. A number of changes noted in recent years include: (1) the diagnosis of ectopic pregnancy was made significantly (P less than 0.05) earlier; (2) a significantly (P less than 0.05) greater proportion of ectopic pregnancies had an association with the following factors: previous tubal surgery, the diagnosis established with ultrasonography, laparotomy preceded by laparoscopy and treatment by conservative surgery; and (3) a significantly (P less than 0.05) smaller proportion of ectopic pregnancies had the diagnosis based on pelvic tenderness or pelvic mass. During the period 1988-90 a total of 126 laparoscopies were performed for suspected ectopic pregnancy, of which 82 (65%) were confirmed to have ectopic pregnancy and 44 (35%) were thought to have no evidence of ectopic pregnancy on laparoscopy. However, two of the latter cases were subsequently found to have an ectopic pregnancy within 2 weeks. The clinical implications of these findings are discussed.     

Spontaneous conception and intrauterine pregnancy in a symptomatic missed abortion of ectopic pregnancy conceived in the previous cycle

We encountered a rare case of combined intrauterine and extrauterinepregnancy that occurred following separate spontaneous ovulations.A 33 year old woman visited our hospital with the chief complaintof abdominal pain on April 16, 1993. Her last menstruation wasfrom March 23 for 6 days. However, the urinary human chorionicgonadotrophin (HCG) on April 19 was 1024 IU/L Pelvic examinationand ultrasonography indicated an extrauterine pregnancy, whichwas confirmed by laparotomy and histo-logical identificationof trophoblast cells. The urinary HCG concentration markedlydecreased after the operation. However, the HCG level increasedagain on the fifth postoperative day, and a gestational sac(11 mm) was identified in the uterine cavity on the 11th post-operativeday, indicating that this intrauterine pregnancy was establishedfollowing spontaneous ovulation which occurred before the removalof the extrauterine pregnancy. This case indicates that a combinedpregnancy can occur not only after simultaneous multiple ovulationsbut also after the separate spontaneous ovulations.