Retrospective Study on Laparoscopic Management of Ectopic Pregnancy

Purpose

To evaluate various laparoscopic methods for management of tubal ectopic pregnancy and study the incidence of ectopic pregnancy including the incidence of cornual ectopic pregnancy and conversion to laparotomy during laparoscopic procedure.

Methods

A retrospective study was conducted in North Point Hospital, Delhi, on all laparoscopies conducted in 4 years, i.e., from January 2008 to December 2011.

Results

Incidence of ectopic pregnancy was 4.62 % (out of all laparoscopic surgeries over 4 years) and that for cornual pregnancy was 4.65 % (out of all ectopic pregnancies); no laparotomy was done for the management of ectopic pregnancy. The site of ectopic pregnancy in the tubal pregnancy varied, with 76.75 % in the ampullary region, 16.27 % isthumic, 2.33 % fimbrial, and 4.65 % in the cornual region. Salpingectomy was done in 53.5 % cases and 46.5 % of patients underwent a conservative approach in the form of salpingostomy.

Conclusion

The laparoscopic management of ectopic pregnancy is a safe and effective option with greatly reduced morbidity.     

Socioeconomic Analysis of the Surgical Management of Ectopic Pregnancies: An Analysis of the National Inpatient Sample

Study ObjectiveTo identify racial and socioeconomic disparities in the surgical management of ectopic pregnancy.DesignRetrospective study. The National Inpatient Sample was sampled from 2015 to 2017 for inpatient hospitalizations for ectopic pregnancy. Cohorts were identified by surgical treatment type—open procedure vs laparoscopic procedure. Race/ethnicity, primary payer status, and median household income were primary variables of interest. Univariate and multivariable analyses were conducted.SettingNationwide inpatient analysis.PatientsWomen presenting for ectopic pregnancy treatment.InterventionsType of surgery.Measurements and Main ResultsOutcome measures were laparotomy vs laparoscopy for treatment. A total of 18 725 cases were identified, 8325 open and 10 400 laparoscopic. Hispanic women were more likely to receive open procedures as treatment for ectopic pregnancy than White women (odds ratio 1.226, p <.001). Women with private insurance were more likely to receive open procedures than women who used self-pay for treatment (odds ratio 0.809, p <.001). Women of lower median income status, <$60 000, were more likely to receive open procedures than women of the fourth quartile income group. Black women predominantly made up the first quartile income group. When controlling for covariates, Black women were not more likely to receive 1 method of surgical procedure over another.ConclusionIncome appears to be related to surgical management of ectopic pregnancy with women of lower median incomes receiving laparotomies over laparoscopic procedures. Equal access to healthcare remains a prudent need in communities of color. Further studies are needed to elucidate surgical decision-making in the management of ectopic pregnancy.     

A Novel Approach to Management of Angular Pregnancies: A Case Series

Cornual, interstitial, and angular pregnancies are terms that are often used interchangeably in both the literature and clinical setting to describe various ectopic pregnancies. The diagnosis of these pregnancies can be difficult, and fear of disrupting an intrauterine pregnancy can cause hesitation during evaluation and management. In our 2 cases, a combination of transvaginal and 3-dimensional ultrasound images provided assistance in the accurate diagnosis of angular ectopic pregnancies. Traditional management of these pregnancies includes a wedge resection for pregnancy resolution. In this set of 2 cases, we describe a unique surgical approach to resolve these pregnancies using operative hysteroscopy.     

持续性异位妊娠的影响因素分析

目的：回顾性分析异位妊娠保守性手术后持续性异位妊娠发生的原因。方法：随机选取我科2008年至2010年因异位妊娠行腹腔镜下输卵管开窗取胚术患者98例,并分成AB两组,A组患者74例术中给予稀释后甲氨喋呤管残腔内注射．B组患者24例未给于药物管腔注射,两组患者于术后第3天及第5天复查血清13一HCG,同时进行相应处理,根据妊娠部位及术中是否用药与发生持续性异位妊娠的概率进行比较。结果：A组74例患者无1例发生持续性异位妊娠,B组24例患者发生持续性异位妊娠3例,其中2例妊娠部位为输卵管伞端妊娠,结论：输卵管伞端妊娠组织开窗清除术与输卵管其他部位开窗取胚术比较发生持续性异位妊娠率高（P〈O．05）。术中输卵管中未给药（甲氨喋呤）比术中给药发生持续性异位妊娠率高（P〈0．05）。     

异位妊娠腹腔镜手术及引流的选择

目的 :总结腹腔镜治疗异位妊娠术式及放置引流的选择。方法 :异位妊娠患者 6 3例 ,其中 32例在腹腔镜下行输卵管线形切开取胚术 ,另 31例行输卵管切除术。按引流的方式不同分为 3个小组 ,分别给予直径 10mm单腔管引流、5mm引流袋管引流和不放引流。术后统计手术时间、术后住院日、引流量、拔除引流管时间、体温、疼痛感、肛门排气时间和穿刺孔渗液的情况。结果 :切除组手术时间平均为 30分钟 ,术后平均住院时间 3天 ,引流量平均 10 0± 80ml,拔除引流管时间平均 12± 10小时 ;而取胚组则分别为 5 0分钟 ,4 .5天、2 0 0± 15 0ml、2 0± 12小时。切除组仅 2例未放置引流管者出现穿刺孔渗液 ,取胚组未放引流管者术后 36小时均有穿刺孔渗液 ,放置单腔管引流者 ,穿刺孔渗液发生率明显低于引流袋管引流者。结论 :异位妊娠腹腔镜手术治疗具有安全、微创、快捷的特点。无再生育要求者 ,最好行输卵管切除 ,此术式腹腔渗出不多。若要保留生育功能而行线形切开取胚术者 ,应置管充分引流。     

Ectopic pregnancy diagnosis and the pseudo-sac

OBJECTIVE: To evaluate the impact of an ultrasound finding of a pseudo-sac (PS), a uterine sac without a double decidual ring or a yolk sac, on the management of cases with possible ectopic pregnancy. DESIGN: A retrospective review of a series of cases. SETTING: A general hospital. PATIENT(S): Seventy-seven patients who had a diagnostic laparoscopy over a period of 3 years for suspected ectopic pregnancy. MAIN OUTCOME MEASURE(S): A logistic regression analysis was conducted to evaluate the effect of the ultrasound finding of a PS on predicting a negative finding at laparoscopy. RESULT(S): The report of a PS is significantly associated with a false-positive diagnosis of ectopic pregnancy. CONCLUSION(S): A diagnosis of PS should not be interpreted as indicative of an ectopic pregnancy because radiological differentiation between an early intrauterine pregnancy failure and an ectopic pregnancy is not possible.     

血清孕酮检测在异位妊娠诊治中的价值探讨

目的探讨血清孕酮在异位妊娠诊断和治疗中的价值.方法选择确诊的异位妊娠病人39例及正常宫内妊娠者37例,检测并比较两组病人血清孕酮值.用受试者工作特性曲线(receiver operator characteristic curve,ROC)来确定用于诊断异位妊娠的血清孕酮临界值(cutoff point).在39例病人中,选择28例给予甲氨喋呤(MTX)治疗,观察在治疗过程中孕酮降至正常值以下所需要的时间和人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)降至正常值以下所需要的时间.结果①正常宫内妊娠的血清孕酮值显著高于异位妊娠(P＜0.01).②推荐以56nmol/L作为血清孕酮诊断异位妊娠的临界值.③在MTX治疗成功的病人中,血清孕酮降至正常水平以下的时间显著短于血hCG降至正常水平以下的时间(P＜0.01).结论异位妊娠的血清孕酮值显著低于正常宫内妊娠,其检测简便、快捷,可以作为一种早期诊断异位妊娠的手段.在治疗异位妊娠的过程中,孕酮降至正常的时间显著短于hCG降至正常的时间,因此它可以作为监测治疗异位妊娠成败与否的良好标志物.     

异位妊娠腹腔镜保守手术和化学药物保守治疗效果的比较

目的:探讨异位妊娠腹腔镜保守手术治疗和化学药物保守治疗近、远期效果的差异。方法:113例患者分腹腔镜保守手术治疗(A组)、化学药物保守治疗(B组)进行比较,分别观察其住院天数、出院时HCG值、术后腹痛、再次宫内妊娠及再次同侧异位妊娠情况。结果:A组较B组住院天数短(P<0.01)、血HCG下降快(P<0.01)、术后腹痛发生率低(P<0.01);再次宫内妊娠机会高(P<0.05);而对预防再次同侧异位妊娠无明显效果(P>0.05)。结论:相对于化学药物保守治疗,腹腔镜保守手术治疗异位妊娠有疗效快、住院时间短、远期并发症少、再次宫内妊娠率高的优势,值得应用;但对于再次同侧异位妊娠的预防效果不明显。     

Role of Ultrasonography in Diagnosis of Ectopic Pregnancy with Clinical Analysis and Management in Tertiary Care Hospital

Purpose of the Study

This study is undertaken to emphasize the role of ultrasonography in the diagnosis of ectopic pregnancy and clinical analysis of the same in a tertiary care referral hospital.

Methodology

One hundred patients with provisional diagnosis of ectopic pregnancy were studied. Physical examination, urine pregnancy test, transabdominal scan using 5 MHz transducer or transvaginal ultrasonography of 7 MHz was done. The diagnosis of ectopic pregnancy was confirmed by direct observation by laparotomy or laparoscopy (which was taken as gold standard).

Results

The study showed ectopic pregnancy was most common in gravida 2 and in age group 26–30 years with most of them having married life <10 years. One or more risk factors were found in 66 % of cases. 54 % of cases presented with acute symptoms, 14 % of cases in shock. Among clinical presentation pain abdomen, history of amenorrhea, bleeding per vaginum, abdominal tenderness, and cervical motion tenderness was most common. In ultrasonography, complex mass in adnexa was present in 60 % of cases and hemoperitoneum in 50 %. 96 % of cases were tubal pregnancy with most of them tubal rupture. In 98 % of cases, radical surgery was done. Salpingectomy was the most common surgery done (90 %). There was no negative laparotomy in this study. There was no maternal mortality in this series.

Conclusions

In all the 100 cases of ectopic pregnancy studied, the ultrasonography provided definitive diagnosis resulting in 100 % sensitivity and 100 % specificity, predictive value of positive test being 100 %. Ultrasonography done in earlier weeks of gestation had sensitivity of 96 % and false negative 4 %.     

输卵管间质部妊娠临床特点变化分析

目的:分析近5年输卵管间质部妊娠的临床特点变化情况。方法:采用回顾性分析方法对90例输卵管间质部妊娠(间质部妊娠组)的临床特点进行分析,并选择同期收治的壶腹部妊娠组(120例)及峡部妊娠组(100例)患者的临床资料进行对照分析。结果:间质部妊娠组临床表现以阴道流血、伴或不伴腹痛为主要症状(60例,66.7%),无症状表现者14例(15.6%),出现单纯腹痛者(16例,17.8%),平均停经天数48.9±10.4天,为间质部妊娠组出现症状时,停经时间最短者。间质部妊娠组患者在停经8周内确诊59例(65.6%),8～12周内确诊27例(30.0%),与壶腹部妊娠组相比差异无统计学意义(P>0.05)。间质部妊娠组术前通过B超检查结合血β-HCG检测提示为间质部妊娠者37例(41.1%),血β-HCG在就诊时平均12579±9548U/L,明显高于壶腹部妊娠组(2132±567U/L)及峡部妊娠组(2079±607U/L),3组比较,差异有统计学意义(P<0.05)。结论:随着检测水平及检测手段的提高,输卵管间质部妊娠发现及诊断时间并不比其他类型的异位妊娠时间晚,输卵管间质部妊娠可以早期发现、早期诊断、早期治疗。     

天花粉、甲氨蝶呤、米非司酮对异位妊娠保守治疗的研究

目的:探索异位妊娠保守治疗的最佳疗效方案。方法:对昆明市延安医院1253例异位妊娠,其中676例行保守治疗。按用药分为用天花粉(A组310例)、甲氨蝶呤(MTX,B组70例)、米非司酮(C组60例)、MTX加米非司酮(D组184例)、天花粉加MTX加米非司酮(E组52例),观察疗效。结果:异位妊娠的保守治疗中E组成功率为94.0%,D组成功率为85.87%,A组成功率为85.16%,B组成功率为81.42%,C组成功率为60.00%。结论:临床显示,异位妊娠疗效方案E组疗效最佳,D组和A组有较高的临床应用优势。其次是B组,疗效最差的是C组。     

两种不同治疗方法对异位妊娠预后影响的临床分析

目的:分析评价药物保守治疗和手术治疗异位妊娠对患者预后的影响。方法:对有生育要求的171例异位妊娠患者,分别对其中65例实施肌内注射MTX(药物组),106例行输卵管切除术(手术组)。结果:药物组中,在经过1或2个疗程MTX化疗后,彻底治愈51例,治愈率为78.5%,平均治疗时间为21±7天。手术组,治愈率为100%。随访2年,两组再次宫内受孕的成功率药物组45.1%,手术组51.9%,差异无显著性(P>0.05)。结论:肌内注射MTX治疗未破裂异位妊娠是一种安全而较为有效的治疗措施,其治疗后再次宫内受孕的成功率与手术组相比无明显差异。     

甲氨蝶呤联合米非司酮或中药治疗异位妊娠的疗效观察

目的:观察甲氨蝶呤(MTX)联合米非司酮或中药治疗输卵管妊娠的疗效。方法:A组:MTX单次肌内注射并口服米非司酮,B组:MTX单次肌内注射并口服中药,对照组:MTX(50 mg/m2)单次肌内注射。定期监测血-βHCG水平及阴道B超监测包块情况直至正常。结果:治愈率A组82.1%、B组81.2%对照组72.5%,A、B两组较对照组明显缩短血-βHCG降至正常所需的时间,减少住院日(P<0.01),A、B两组间没有明显的差异(P>0.05),但B组副反应明显比A组少(P<0.05)。结论:MTX单次肌内注射联合中药治疗输卵管妊娠疗效好、副反应少,值得临床推广。     

剖宫产后切口妊娠的临床诊治分析

目的:研究剖宫产后子宫切口妊娠的临床表现及治疗方法等特征,为临床医生早期诊断、早期处理本病提供依据。方法:对25例患者的病史、临床表现、诊断方法以及治疗方法进行回顾性分析。结果:25例患者中有23例经阴道超声检查或彩色多普勒超声检查确诊;本病初诊误诊19例,误诊率76%,25例患者中保守治疗22例,21例痊愈,占95.45%;2例治疗失败而行全子宫切除术。结论:有剖宫产史的妇女因停经就诊时,要常规行阴道超声检查,对阴道超声怀疑切口妊娠的病例,有必要行彩色多普勒超声检查;彩色多普勒超声检查可作为诊断切口妊娠的主要方法;甲氨蝶呤加清宫术可作为治疗切口妊娠的主要方法,可有效地避免子宫切除。     

Effect of Pregnancy on the Management and Outcomes of Ovarian Torsion: A Population-Based Matched Cohort Study

Study Objective

To compare the treatment and surgical outcomes of ovarian torsion in pregnant and nonpregnant women.

不同剂量米非司酮治疗异位妊娠的临床观察

目的:探讨不同剂量的米非司酮保守治疗异位妊娠的临床疗效及其最适有效剂量。方法:将确诊为异位妊娠并有保守治疗指征的患者90例随机分为A、B、C 3组各30例,分别口服米非司酮100 mg、150 mg、200 mg每日1次连服3天,根据血-βHCG值再将各组患者分为甲、乙两组。比较各组的有效率、重复用药及副反应情况。结果:甲乙两组总的有效率比较差异有显著性(P<0.05),A、B及B、C两组间有效率比较差异无显著性,A、C两组比较差异有显著性(P<0.05)。A、B、C 3组中A甲、B甲、C甲间有效率比较差异无显著性,A乙、B乙及B乙、C乙两组间有效率比较差异无显著性,而A乙组与C乙组的有效率比较差异有显著性(P<0.05)。结论:米非司酮治疗异位妊娠安全、有效、经济、毒副反应小、依从性强。用药剂量与血-βHCG值有关,当血-βHCG值小于2000 U/L时用100mg至150 mg,每日1次连服3天;当血-βHCG值在2001 U/L至5000 U/L时用150 mg至200 mg,每日1次连服3天,均能收到较好的疗效。     

16例重复多次异位妊娠诊治分析

目的 :分析重复多次异位妊娠的诊断、治疗及结局。方法 :回顾性分析 1 995年 5月至 2 0 0 0年 1 2月我院 1 6例重复 2次以上异位妊娠的诊断 ,前次妊娠盆腔粘连情况、治疗方式与本次妊娠之间的关系。结果 :重复 2次以上异位妊娠 1 6例 ,发生率为 0 697% ,重复异位妊娠发生于原患侧与对侧比例基本相同。经腹保守性手术后再次异位妊娠 85 7%发生于原患侧 ,腹腔镜保守手术无同侧复发 ,两者有显著差异 (P <0 .0 5)。药物保守后原患侧再次异位妊娠与保守性手术相比无差异 (P >0 .0 5)。结论 :异位妊娠药物保守治疗与保守手术效果相近。如何防止异位妊娠重复发生 ,提高宫内妊娠率有待进一步研究     

异丙酚与氯胺酮联合麻醉用于异位妊娠腹腔镜手术68例分析

目的:探讨氯胺酮与异丙酚静脉全身麻醉用于异位妊娠腹腔镜治疗的安全性。方法:对68例异位妊娠腹腔镜治疗患者选择氯胺酮与异丙酚静脉麻醉,观察生命体征、麻醉效果、副反应、苏醒时间等。结果:注射氯胺酮后8例患者MAP升高达到25%;注射异丙酚后25例RR<12/min,16例SpO2<0.93,6例HR<60/min;气腹5分钟时5例RR<12/min、但SpO2维持正常;气腹10分钟和气腹15分钟时,HR、MAP、RR、SpO2均在正常标准范围内;术毕意识恢复时间10.9±2.8分钟,定向力恢复时间12.6±3.1分钟,无躁动、谵妄、恶心呕吐、尿潴留等。结论:氯胺酮与异丙酚静脉麻醉是短时间异位妊娠腹腔镜治疗的可选择的一种麻醉方式,可达到安全、微创、经济等目的。