腹腔镜与开腹手术治疗宫外孕疗效分析

目的：对比分析腹腔镜与开腹手术治疗宫外孕的临床效果,以期找出更好的治疗方法供临床参考。方法：采取回顾性分析法将笔者所在医院2013年6月至2014年6月行宫外孕手术的127例患者随机分为两组,行腹腔镜手术者65例,设为观察组,行开腹手术者62例,设为对照组,观察比较两组患者术中及术后至出院前的一系列相关临床症状。结果：观察组手术时间、术中出血量、术后恢复时间及住院时间为优于对照组,两组比较差异具有统计学意义（P〈0.05）。结论：采用腹腔镜手术治疗宫外孕更为安全,对患者创伤小,出血量少,术后恢复快,且可保留生育功能,对患者康复有益,值得在临床广泛推广和应用。     

腹腔镜手术治疗宫外孕的安全性及疗效分析

目的 研究腹腔镜手术治疗宫外孕的疗效和安全性。方法 选取54例宫外孕患者,遵循随机、平均的原则,抽签法1:1分为对照组与研究组,每组27例。对照组采用传统开腹手术治疗,研究组采用腹腔镜手术治疗。比较两组治疗效果、临床指标、恢复时间及并发症发生情况。结果 对照组、研究组总有效率分别为85.19%、92.59%,比较差异无统计学意义（P>0.05）。研究组术中出血量少于对照组,手术时间、导尿管留置时间、下床活动时间及住院时间均短于对照组,差异有统计学意义（P<0.05）。研究组并发症发生率低于对照组,差异有统计学意义（P<0.05）。结论 腹腔镜手术治疗宫外孕疗效确切,手术损伤较小且效率较高,有利于患者术后康复,并发症发生率低,安全性理想。     

腹腔镜手术与开腹手术治疗早期子宫颈癌的对比分析

目的 :探讨腹腔镜手术治疗早期子宫颈癌的价值。方法 :回顾性分析接受腹腔镜手术 (15例 )和剖腹手术(17例 )治疗的临床Ⅰ期宫颈癌患者的临床资料 ,比较两组的手术时间、术中出血量、手术并发症、术后恢复情况及疾病复发等。结果 :腹腔镜组 1例因膀胱损伤而中转开腹。 2例腹腔镜下广泛性子宫切除手术时间分别为 2 0 5分钟和 115分钟 ,出血分别为 75 0ml和 2 0 0ml;12例腹腔镜下广泛性子宫切除及盆腔淋巴结清扫术手术时间平均 30 3 7分钟 ,术中出血平均 393 3ml,平均切除淋巴结 15 3个。剖腹手术组手术时间平均 2 18 0分钟 ,术中出血平均 384 1ml,平均切除淋巴结 16 2个。腹腔镜和剖腹手术组术后病率分别为 5 0 %和 47 1%。腹腔镜组髂外静脉损伤 2例 ,剖腹手术组髂总静脉损伤 1例。两组术后尿潴留分别为 3例和 4例 ,淋巴囊肿分别为 4例和 2例。腹腔镜组手术时间明显长于剖腹手术组 (P<0 .0 1) ,其余指标差异无统计学意义。术后随访 3月至 4年 ,两组各 1例复发。结论 :腹腔镜下广泛性子宫切除及盆腔淋巴结清扫术可作为早期子宫颈癌手术治疗的方法之一。     

输卵管妊娠腹腔镜保守手术治疗与传统开腹手术治疗对比分析

目的:探讨输卵管妊娠腹腔镜保守手术与传统开腹手术的治疗效果.方法:对我院收治的100例输卵管妊娠的患者,分为腹腔镜组50例与开腹手术组50例,对两组术中、术后情况进行比较分析.结果:腹腔镜组术中出血量、住院时间、术后肛门排气时间、离床活动时间与开腹组比较,差异有统计学意义或高度统计学意义(P＜0.05或P＜0.01),各指标优于开腹组.术后随访2年,腹腔镜组再次宫内妊娠39例(78%),开腹手术组再次宫内妊娠29例(58%),差异有统计学意义(P＜0.05).结论:应用腹腔镜行输卵管妊娠保守手术治疗优于传统的开腹手术,腹腔镜手术可以作为输卵管妊娠且有生育要求患者保守手术的首选.     

腹腔镜手术与开腹手术治疗早期子宫内膜癌的临床对比分析

目的　探讨腹腔镜用于早期子宫内膜癌手术治疗的可行性。方法　回顾性分析 1998年 1月至 2 0 0 3年 8月间用腹腔镜完成手术治疗的子宫内膜癌患者 2 4例作为研究组 ,随机选择同期经过开腹手术治疗的患者 41例作为对照组 ,对两组围手术期的情况和生存情况决定是否进行比较。结果　两组患者术前情况 ,如体重、病情严重程度、病理分化程度和肌层浸润深度比较 ,差异均无显著性 (P >0 0 5)。研究组平均手术时间 97min ,对照组为 13 4min ,差异有极显著性 (P <0 0 0 1) ;平均手术出血量分别为 163和 2 59ml,差异无显著性 (P =0 0 59) ;平均切除盆腔淋巴结数量分别为 13 6和19 6个 ,差异无显著性 (P >0 0 5) ;术后并发症发生率分别是 12 %和 2 4% ,差异有显著性 (P <0 0 5) ;术后平均住院天数分别为 6 3和 9 6d ,差异有极显著性 (P <0 0 0 1)。两组病理类型和手术病理分期比较 ,差异无显著性 (P >0 0 5) ;术后放疗、化疗和生物治疗等辅助治疗比较 ,差异无显著性(P >0 0 5) ;剔除失访病例后 ,两组生存率分别为 10 0 %和 97% ,差异无显著性 (P >0 0 5)。结论　小样本量的临床研究表明 ,在严格掌握指征的条件下腹腔镜治疗早期子宫内膜癌是可行的 ,并且有手术创伤小、恢复快的优点 ,值得进行多中心、前瞻     

输卵管妊娠腹腔镜保守手术治疗与传统开腹手术治疗对比分析

目的:分析输卵管妊娠腹腔镜保守手术与传统开腹手术两种治疗方法的疗效差异。方法:将2009年6月至2011年3月到我院妇产科进行治疗的120例输卵管妊娠患者随机分为两组,分别为腹腔镜组和开腹手术组,每组各60例患者,对两组患者术后情况进行对比分析。结果:腹腔镜组术患者的组术中出血量、手术时间、住院时间、肛门排气时间、开始离床活动时间,明显少于和短于开腹手术组,两组相比差异有显著性意义(P<0.05)。结论:腹腔镜下进行输卵管妊娠保守手术治疗具有出血量少,手术时间、住院时间、肛门排气时间、开始离床活动时间短的优点,其疗效明显优于传统开腹手术。     

53例宫外孕腹腔镜治疗的护理体会

目的:了解宫外孕影响因素,通过对53例腹腔镜治疗宫外孕患者采用针对性护理与观察,为促进为进一步对做好宫外孕腹腔镜治疗的护理工作提供科学依据。方法:对患者基本情况调查,用Logistic回归分析方法分析影响宫外孕的危险因素。对宫外孕患者制定护理计划,积极采取相关护理措施,加强术前、术后护理。结果:宫外孕患者危险因素是妊娠阶段、避孕药服用史、有阴道出血或腹痛等症状。53例患者均痊愈出院。结论:对腹腔镜治疗宫外孕实施良好的护理对手术患者早日康复发挥重要的作用,可提高患者治愈率、缩短其住院时间、减轻患者痛苦。     

46例宫外孕腹腔镜治疗的护理体会

目的:了解宫外孕影响因素,通过对46例腹腔镜治疗宫外孕患者采用针对性护理与观察,为促进为进一步对做好宫外孕腹腔镜治疗的护理工作提供科学依据。方法:对患者基本情况调查,用Logistic回归分析方法分析影响宫外孕的危险因素。对宫外孕患者制定护理计划,积极采取相关护理措施,加强术前、术后护理。结果:宫外孕患者危险因素是妊娠阶段、避孕药服用史、有阴道出血或腹痛等症状。46例患者均痊愈出院。结论:对腹腔镜治疗宫外孕实施良好的护理对手术患者早日康复发挥重要的作用,可提高患者治愈率、缩短其住院时间、减轻患者痛苦。     

腹腔镜与开腹手术治疗异位妊娠术后受孕率对比

目的:探讨腹腔镜保守性手术与开腹保守性手术治疗异位妊娠术后宫内受孕率的差异。方法:回顾性分析有生育要求的83例异位妊娠病例,其中行腹腔镜保守性手术43例,开腹保守性手术40例,术中配合患侧输卵管系膜处注射甲氨喋呤,比较两组手术术后输卵管通畅率和术后18个月内宫内受孕率。结果:腹腔镜组术后输卵管通畅率(88%)、宫内受孕率(61%)、再次异位妊娠率(7%);开腹组术后输卵管通畅率(73%)、宫内受孕率(48%)、再次异位妊娠率(8%)。结论:输卵管保守性手术后宫内妊娠率高,而再次异位妊娠率不增加,适合要求保留生育功能的年轻患者。     

对比腹腔镜手术与开腹手术治疗宫外孕的疗效

目的对比腹腔镜手术与开腹手术治疗宫外孕的疗效及术后情况。方法择取我院2013年11月~2014年11月收治的宫外孕患者92例作为研究对象,将其随机分成研究组和对照组,各46例。对照组采取开腹手术治疗;研究组采取腹腔镜手术治疗,对比两组患者的手术疗效。结果研究组患者的住院时间、手术时间、尿管留置时间、肛门排气时间及术后腹痛时间显著短于对照组,术中出血量显著低于对照组,差异有统计学意义(P0.05)。结论采用腹腔镜手术方法治疗宫外孕具有较好的疗效,能减少患者的治疗时间,促进患者健康的恢复。值得临床推广应用。     

Laparoscopy versus laparotomy in the management of ectopic pregnancy with massive hemoperitoneum

Objective

To compare the safety and feasibility of operative laparoscopy versus laparotomy in women with ruptured ectopic pregnancy and massive hemoperitoneum.

Methods

In a retrospective cohort study at a university-affiliated medical center, records of women with ruptured ectopic pregnancy and massive hemoperitoneum (> 800 mL) were reviewed.

Results

Sixty women were diagnosed with ruptured ectopic pregnancy and massive hemoperitoneum: 48 underwent emergency laparoscopy; 12 underwent emergency laparotomy. There was no difference in hemodynamic status at presentation between the groups. Median operating time was significantly shorter in the laparoscopy group (50 minutes [range, 43–63 minutes] vs 60 minutes [range, 60–72 minutes]; P = 0.01). Median intra-abdominal blood loss was significantly greater in the laparotomy group (1500 mL [range, 1400–2000 mL] vs 1000 mL [range, 800–1200 mL]; P = 0.002). There was no difference between the groups regarding treatment with blood products, perioperative complications, and hospitalization period.

Conclusion

In patients with ruptured ectopic pregnancy and massive hemoperitoneum, laparoscopy is feasible and safe, with significantly shorter operating times compared with laparotomy. While the mode of surgery should be based on the surgeon’s experience and preference, the significantly lower hemoperitoneum volume associated with laparoscopy may be a reflection of shorter operating times and quicker hemorrhage control.     

Primary omental ectopic pregnancy

Omental ectopic pregnancy is a rare form of ectopic pregnancy. Presented here is a case primary omental ectopic pregnancy according to Studdiford's criteria. This patient presented with epigastric pain and anemia without vaginal bleeding, lower abdominal or pelvic pain. Pregnancy status was confirmed after admission. Transvaginal ultrasound examination revealed intrauterine contraceptive device in situ and a large amount of free peritoneal fluid, but no intrauterine sac or adnexal mass. Laparoscopy was performed but pelvic pathology did not account for the 2500 mL of haemoperitoneum. Laparotomy was carried out and partial omentectomy was performed.     

异位妊娠患者保留生育功能的处理

目的:探讨腹腔镜下对有生育要求的异位妊娠患者进行保留及恢复生育功能的处理方法及原则。方法:回顾性分析82例有生育要求的异位妊娠患者应用腹腔镜技术治疗的盆腔状态以及手术方式的选择。结果:①对侧输卵管情况：对侧输卵管通畅者65．9％(54／82)；不通畅者29．3％(24/82)；对侧输卵管缺如者4．9％(4/82)；②盆腔炎性粘连情况：盆腔不同程度粘连者占64．6％(53／82)；③子宫内膜异位症发生率情况：近9个月观察的29例患者中，62．1％(18／29)合并子宫内膜异位症。其中83．3％(15／18)为Ⅰ期；16．7％(3／18)为Ⅱ期(修正的AFS分期)；④手术方式的选择：56例(68．3％)保留患侧输卵管，26例(31．7％)行患侧输卵管切除术。结论：异位妊娠的盆腔状态异常率68．3％(56/82)，合并炎症粘连和／或子宫内膜异位症；治疗有生育要求的异位妊娠患者时，应注意评估患者的潜在生殖能力，尽量解除不孕的隐患，保留和恢复其生殖功能。     

Laparoscopic management of primary hepatic pregnancy

A 30-year-old woman presented with epigastric pain with elevated serum human chorionic gonadotropin level (hCG), absence of intrauterine gestational sac and absence of an abnormal adnexal mass on pelvic ultrasonography. Laparoscopy revealed a ruptured hepatic ectopic pregnancy. This was removed by laparoscopic suctioning and haemostasis secured with Surgicel^® Fribrilla™ Absorbable Hemostat. Intramuscular methotrexate was administered post-operatively. Patient recovered uneventfully and serum hCG returned to normal.     

Laparoscopic management of a cornual ectopic pregnancy

There are various possibilities for treating cornual ectopic pregnancies, including medical approaches using methotrexate and surgical approaches using laparoscopy. This report describes the laparoscopic management of a large cornual ectopic pregnancy associated with a high -human chorionic gonadotropin level and reviews the techniques and outcomes of conservative treatment described in the literature.     

Operative laparoscopy for unruptured ectopic pregnancy in a caesarean scar

Eight women diagnosed by transvaginal ultrasonography with unruptured caesarean scar pregnancy underwent operative laparoscopy as an alternative treatment to laparotomy. The ultrasonographic diagnosis of caesarean scar pregnancy was confirmed in all women at laparoscopy. None of the women required conversion of the procedure to laparotomy. The total operative time ranged from 75 to 120 minutes. The total blood loss was limited, ranging from 50 to 200 ml. All women tolerated the operation well and had uneventful recoveries. Our results show that in the hands of a well-trained operator, laparoscopy appears to be a reasonable alternative for the management of an unruptured caesarean scar pregnancy.     

Laparoscopic management of ectopic pregnancies in unusual locations

ObjectiveThe aim of this study was to evaluate the feasibility and efficacy of laparoscopic surgery for patients with ectopic pregnancies in unusual locations.Materials and methodsThis is a retrospective case series of 31 patients from 6 weeks to 10 weeks postmenstrual who were referred for diagnosis and treatment and suspected of having an unruptured cesarean scar pregnancy (CSP) or cornual pregnancy (CP). The diagnosis was confirmed with transvaginal ultrasound, and all of the patients underwent laparoscopic management.ResultsA diagnosis of CSP or CP was confirmed in all of the patients during the laparoscopic procedure. None of the patients required conversion to laparotomy. The total operative time ranged from 40 minutes to 120 minutes. The total blood loss was limited, ranging from 30 mL to 200 mL. All of the women tolerated the operation well and had uneventful recoveries.ConclusionWhen performed by a well-trained gynecologist, laparoscopy appears to be a reasonable alternative for the treatment of unruptured CSP or CP.