手术治疗输卵管远端梗阻性不孕的临床分析

目的 研究开腹及腹腔镜治疗输卵管远端梗阻性不孕及术中通液压力不同对术后妊娠情况的影响.方法 在我院住院手术治疗的输卵管远端梗阻性不孕患者(82例),自愿选择开腹(38例)和腹腔镜(44例),同时记录术中通液压力,比较两组术后妊娠及不同通液压力术后的妊娠情况.结果 开腹与腹腔镜两组间宫内妊娠率比较差异无统计学意义(P>0.05).通液压力较小组中,腹腔镜组宫内妊娠率与开腹组比较差异有统计学意义(P<0.05).结论 我们可以根据术中通液压力情况,在患者充分知情同意的情况下采取不同的手术方式,以提高术后宫内妊娠率. Abstract： Objective To study the effect of laparotomy and laparoscopy treatment of oviduct obstructive acyesis and their different pressure of hydrotubation during operation on post-operative pregnancy. Methods Eighty-two cases of oviduct obstructive acyesis in our hospital were treated by laparotomy (38 cases)or laparoscopy(44 cases), and their pressure of hydrotubation were recorded.Results There was no significant difference in the rate of intrauterine pregnancy and ectopic pregnancy between laparotomy and laparoscopy (P>0.05). In the lower pressure group, there was significant difference in the rate of intrauterine pregnancy beween laparotomy and laparoscopy.Conclusions In the condition of the patients' understanding and agreement, we can take the different operation Methods in order to improve the patients' intauterine pregnancyrate on the basis of the pressure of the hydrotubation.     

经腹腔镜手术治疗宫外孕疗效分析

目的 探讨腹腔镜在宫外孕手术治疗中的应用及治疗效果.方法 以72例经腹腔镜手术治疗的宫外孕患者为治疗组,随机选择同期经急诊剖腹手术治疗的宫外孕患者60例为对照组,比较两组患者术中及术后情况.结果 术后两组患者经病理检查确诊为输卵管妊娠,两组患者均无并发症发生;治疗组患者术中平均出血量、手术时间、术后下床活动及肛门排气时间、住院天数均显著低于对照组(P＜0.05).结论 腹腔镜手术治疗宫外孕创伤小、手术时间短、腹部瘢痕小,术后恢复快,下床活动时间、肛门排气时间及住院天数比较均少于剖腹手术,患者乐于接受,术后生活质量提高,与开腹手术相比优势明显. Abstract： Objective To evaluate the therapeutic efficacy and application of laparoscopic surgery for the treatment of ectopic pregnancy. Methods Seventy-two patients with ectopic pregnancy treated by laparoscopic surgery were selected as treatment group. Sixty patients with ectopic pregnancy treated by emergency laparotomy were randomly selected as control group. Intraoperative and postoperative situation of patients in the two groups were compared. Results All patients in the two groups were pathologically diagnosed as tubal pregnancy.No complications occurred in both two groups.The average amount of bleeding within surgery, time of operation, time of postoperative out-of-bed activity, and time of anal exhaust, hospital days in treatment group were significantly lower than that in control group (P<0.05). Conclusions Treatment of ectopic pregnancy by laparoscopic operation has the advantage of less trauma, short surgery time, rapid recovery, small abdominal scar.Time of operation, postoperative out-of-bed activity, anal exhaust, and hospital days were less than that of laparotomy.The patients are willing to accept laparoscopic operation compared with laparotomy due to improve quality of life.     

血清孕酮及绒毛膜促性腺激素联合检测对妊娠早期结局预测的价值

目的 探讨在妊娠早期联合检测血清孕酮(P)及48 h绒毛膜促性腺激素(β-HCG)的上升情况对早期妊娠结局的预测价值.方法 采用ECL/RTA技术,将287例孕妇分为正常对照组、先兆流产组、难免流产组、异位妊娠组,研究血清孕酮、48 h β-HCG的上升情况与妊娠结局变化的关系.结果 正常对照组、先兆流产组血清孕酮及β-HCG值明显高于难免流产及异位妊娠组.血清孕酮>20 μg/L者,出现宫内妊娠结局不良及异位妊娠的比例较低;妊娠早期孕酮<10 μg/L者宫内妊娠结局不良及异位妊娠的比例高,组间比较差异有统计学意义(P＜0.05).48 h β-HCG上升理想组比上升不理想组宫内妊娠结局良好比例较高,宫内妊娠结局不良率和异位妊娠率相对较低,差异有统计学意义(P＜0.05).结论 在妊娠早期联合检测血清孕酮及48 h β-HCG上升情况对于妊娠结局的预测及指导治疗具有重要的临床价值. Abstract： Objective To investigate the predictive value of the combined detection of serum progesterone (P) and human chorionic gonadotropin (β-HCG) rise in 48 h on early pregnancy outcome.Methods Two hundred and eighty-seven cases of pregnant women were divided into normal control group,threatened abortion group,inevitable abortion group and ectopic pregnancy group. Using the ECL/RTA technology, the relationships of P and pregnancy outcome, β-HCG rise in 48 h and changes of pregnancy outcome were observed. Results P and β-HCG of the normal group and threatened abortion group were significantly higher than other groups. People whose P was greater than 20 μg/L appeared lower adverse intrauterine pregnancy outcome and ectopic pregnancy. People whose P was less than 10 μg/L during early pregnancy appeared higher rate of adverse intrauterine pregnancy outcome and ectopic pregnancy. The differences between the two groups were significant (P<0.05). The group whose 48 h β-HCG increased significantly had higher rate than the one whose 48hβ-HCG rise was not satisfactory in good intrauterine pregnancy outcome. Adverse outcomes of intrauterine pregnancy rate and ectopic pregnancy rate were relatively low. There were significant differences between the two groups (P<0.05) Conclusions During early pregnancy, the combined detection of P and 48 h β-HCG rise had important clinical value in predicting the pregnancy outcome and guiding therapy.     

两种保守性手术治疗输卵管妊娠临床分析

目的:比较经腹腔镜与开腹两种子选手保守性手术治疗输卵管妊娠的临床效果。方法:将125例输卵管妊娠患者随机分为两组,65例采取腹腔镜保守性手术治疗(腹腔镜组),60例采取开腹保守性手术治疗(开腹组),观察比较两组手术效果。结果:腹腔镜组手术时间、术中出血量及住院时间明显小于开腹组,差异有统计学意义(P<0.05),两组患者血β-hCG恢复正常时间差异无统计学意义(P>0.05)。结论:腹腔镜保守性手术治疗输卵管妊娠手术创伤小,患者术后恢复快,并达到同开腹保守性手术同样的治疗效果,值得临床推广使用。     

异位妊娠的药物保守治疗

异位妊娠(ectopic pregnancy)包括最常见的输卵管妊娠(tubal pregnancy)及少见的卵巢妊娠(ovarian pregnancy)、宫颈妊娠(cervical pregnancy)、腹腔妊娠(abdominal pregnancy)、间质部妊娠(interstitial pregmancy).近年来发病率明显增加,但随着B超、血HCG、腹腔镜技术的应用和提高,使早期诊断成为现实、保守治疗成为可能.经过数年来的临床实践,已取得了令人信服的良好结果,为人们所认可,不久的将来有希望成为异位妊娠治疗的首选方法.     

腹腔镜手术与开腹手术对宫外孕术后受孕率的影响研究

目的比较腹腔镜手术与开腹手术对宫外孕患者术后受孕率的影响.方法根据手术方式的不同将宫外孕患者分为腹腔镜组(50例)和开腹组(40例),对患者进行随访,了解并比较两组患者的输卵管再通和术后受孕情况.结果腹腔镜组患者术后输卵管通畅率为88.0%,宫内妊娠率为74.0%,再次宫外孕发生率为6.0%;开腹组患者术后输卵管通畅率为67.5%,宫内妊娠率为47.5%,再次宫外孕发生率7.5%;两组患者术后输卵管通畅率和宫内妊娠率差异均具有统计学意义(P<0.05).结论腹腔镜手术增加了术后输卵管通畅率和宫内妊娠率,未增加宫外孕再次发生的机率,适合要求保留生育功能的患者.     

腹腔镜与开腹手术治疗输卵管妊娠的疗效比较

目的比较两种手术方法治疗输卵管妊娠的疗效.方法对腹腔镜手术和开腹手术治疗输卵管妊娠的结果进行比较分析.结果两种方法手术成功率均为100%,未发生1例严重并发症;两组术中出血量、手术时间、术后住院日、感染率、肛门排气时间、术后腹腔镜组均少于开腹组(P＜0.01).结论对输卵管妊娠的治疗腹腔镜手术优于开腹手术,但应注意适应证及提高手术熟练程度,以避免损伤输卵管,导致再次输卵管妊娠的发生.     

腹腔镜手术在异位妊娠治疗中的价值

目的 比较腹腔镜手术与传统开腹手术在异位妊娠中的应用,探讨腹腔镜在异位妊娠中的诊疗价值及对术后生殖功能的影响.方法 分析258例异位妊娠患者的临床治疗资料,其中腹腔镜手术169例,镜下输卵管切除54例(31.95％),输卵管保守性手术115例(68.05％);开腹手术89例,输卵管切除31例(34.83％),输卵管保守性手术58例(65.17％),对2组术中及术后情况进行比较.结果 2组术中出血量、手术时间、导尿管留置时间、肠道功能恢复时间、术后镇痛药使用、住院时间等,差异有统计学意义;腹腔镜组住院费用高于开腹组;术后输卵管通畅率、宫内妊娠率腹腔镜组明显优于开腹组.结论 腹腔镜是治疗异位妊娠的首选方法.     

腹腔镜与开腹手术治疗异位妊娠的比较研究

目的 探讨腹腔镜与开腹手术治疗异位妊娠的临床意义和安全性.方法 回顾性分析458例异位妊娠手术治疗的临床资料,其中腹腔镜手术329例,开腹手术129例,比较两组术中与术后情况.结果 腹腔镜下输卵管切除术201例(61.09%),输卵管切开取胚术123例(37.39%),卵巢部分切除术5例,无1例转开腹.开腹手术:输卵管切除术104例(80.62%),输卵管切开取胚术23例(17.83%),卵巢部分切除术2例.两组均未发生脏器损伤、穿刺伤、电损伤等并发症.术后血β-hCG逐渐转阴,病理均显示异位妊娠.比较两组手术方式、手术时间、术后留置尿管时间、肛门排气时间、住院天数等有显著性意义;住院费用腹腔镜明显高于开腹组(P＜0.05).结论 腹腔镜手术创伤小、术中出血少、术后恢复快、住院时间短、且外形美观,是治疗异位妊娠安全、理想的手术方式.     

腹腔镜与开腹下输卵管妊娠保守性手术的对比研究

目的探讨腹腔镜手术与开腹手术对输卵管妊娠保留输卵管性手术的效果与安全性。方法以腹腔镜下行输卵管妊娠病灶清除术110例为腹腔镜组,以同期开腹手术下输卵管妊娠病灶清除术122例为开腹手术组,比较其手术出血量、肛门排气时间、术后镇痛、术后发热等情况。结果腹腔镜组与开腹组的术中出血量分别为(25.2±12.22)mL和(62.1±14.33)mL,肛门排气时间分别为(20.1±5.2)h及(33.2±12.8)h,两组比较差异有统计学意义。腹腔镜组术后镇痛率(6.36%)、术后发热率(9.09%)明显低于开腹手术组(32.0%和21.31%),P<0.05;腹腔镜组术后持续性异位妊娠发生率(3.64%)和开腹组(2.46%)相比无明显差异(P>0.05)。结论腹腔镜下输卵管妊娠的保守性手术安全有效,对有生育要求的妇女更具优势。     

腹腔镜手术与开腹手术治疗异位妊娠的疗效比较

目的：探讨腹腔镜手术治疗异位妊娠的临床优势。方法：回顾性分析210例异位妊娠,其中腹腔镜组86例,开腹组124例,对两组临床资料进行分析。结果：比较腹腔镜组和开腹组的平均手术时间、术中出血、术后使用抗生素时间、术后排气时间、住院天数,前者明显少于后者,差异有显著性（均P〈0．05或P〈0．01）;两者住院费用比较,差异无显著性（P〉0．05）．结论：腹腔镜手术治疗异位妊娠在基层医院易普及、安全有效．     

异位妊娠药物治疗的疗效观察

目的 寻找一种简单、有效、成功率高、不良反应小且不影响生育功能的药物治疗异位妊娠的方法.方法 本院249例异位妊娠患者,其中136例行保守治疗.按用药随机分为A组46例,氨甲蝶呤(MTX)50 mg/ml单次肌肉注射并口服米非司酮(Ru486);B组45例,MTX单次肌肉注射(50 mg/ml);C组45例,口服米非司酮.定期监测三组患者血β-人绒毛膜促性腺激素(β-HCG)水平及阴道B超监测包块情况.结果 治愈率A组97.8%,B组86.7%,C组88.9%,A组较B、C两组明显缩短血β-HCG降至正常所需的时间,减少住院日(P<0.01),B、C两组比较差异无统计学意义(P＞0.05).结论 甲氨蝶呤和米非司酮联合用药治疗异位妊娠降低了单独用药剂量,具有疗效高、疗程短、不良反应小的优点,值得临床推广应用. Abstract： Objective To find a simple, effective, high rate of success of small toxicity without affecting the reproductive function of drug treatment of ectopic pregnancy. Methods Two hundred and forty-nine cases of hospital patients with ectopic pregnancy, in which 136 treated conservatively. According to medication were randomly divided into group A (46 cases): methotrexate (MTX) 50 mg/ml single intramuscular injection and oral administration of mifepristone (Ru486);Group B (45 cases): MTX single intramuscular injection (50 mg/ml);Group C (45 cases): Mifepristone. regular monitoring of serum β-HCG levels and vaginal mass of B-monitored. Results The cure rate in group A was 97.8%,in group B was 86.7%, in group C was 88.9%. There was significantly reduced serum β-HCG dropped to normal time required to reduce the hospital stay in group A than that in group B,C(P<0.01),there was no significant difference between group B and group C (P>0.05). Conclusions The combination therapy with methotrexate and mifepristone treatment of ectopic pregnancy reduced the single dose, with high efficacy, short duration of side effects of the merits and is worth clinical application.     

输卵管妊娠手术方式对于术后妊娠的的影响

目的探讨输卵管妊娠病人采取不同手术方式对于术后妊娠的影响。方法回顾性总结2000～2005年间本院住院手术病人中行输卵管开窗术或者切除术有意愿再次妊娠患者并术中行卵管通液术证实对测卵管通畅135例进行3～4年随访。其中A组62例,行开窗术。B组73例行输卵管切除术。比较两组手术方式对于再次妊娠的影响。结果比较术后3～4年内妊娠宫内妊娠率及再次异位妊娠发生率。宫内妊娠率：A组25例宫内妊娠。B组16例宫内妊娠,两组比较p〈0.05有显著差异;异位妊娠率：A组15例,B组8例,两组比较p〈0.05,差异有显著性。结论对于采取输卵管开窗术应推荐。因为保留输卵管增加了总的妊娠率,增加了宫内妊娠率。尤其要求再生育者,保留输卵管应建议。对于无生育要求者建议切除患侧卵管,因为保留卵管同时增加了再次异位妊娠率。     

腹腔镜手术与开腹手术治疗宫外孕临床效果研究

目的研究与探讨腹腔镜手术与开腹手术治疗宫外孕临床效果。方法回顾性分析我院2011年5月～2012年3月收治的128例宫外孕患者的临床资料,比较腹腔镜手术(n=71)与开腹手术(n=57)的手术时间、术中出血量、肛门排气时间、留置尿管时间、住院时间及并发症发生情况。结果腹腔镜组手术效果明显优于开腹组,其手术时间较开腹组明显缩短,术中出血量明显减少,肛门排气时间、留置尿管时间和住院时间显著缩短,并发症明显减少,两组比较差异有统计学意义(P<0.05)。结论腹腔镜手术治疗宫外孕具有手术时间短、术中出血少、术后恢复快、并发症少、美容效果好等优点,可作为临床宫外孕治疗的首选术式。     

腹腔镜与开腹手术治疗200例宫外孕的护理对比分析

目的探讨腹腔镜与开腹手术治疗200例宫外孕的护理差异。方法回顾性分析我院近年来收治的200例宫外孕患者的临床资料。结果 2组患者的手术时间、术中出血量、术后体温、疼痛消失时间、肛门排气时间、术后活动时间、住院时间等比较,P〈0.01,有显著性差异。结论根据患者的不同术式,采取有针对性的护理措施,可有效避免手术并发症,促进患者如期康复。腹腔镜下手术治疗宫外孕具有恢复快的优势。     

宫内外复合妊娠1例的临床分析

为探讨宫内外复合妊娠的临床诊断与治疗,笔者在分析了本院1例宫内外复合妊娠病例资料并复习国内外文献报道后发现：自然受孕的复合妊娠发生率低。复合妊娠是临床易被漏诊而延误诊治的病理妊娠疾病,其临床表现与一般异位妊娠相似,超声检查有助于诊断,腹腔镜手术是最好的诊治手段。临床医师应加强生育期女性罹患本病的诊断意识,加强超声检测的准确度有助于该病的早期诊断,是避免发生异位妊娠破裂时对患者造成危害的关键。腹腔镜手术是安全的治疗方式,有利于宫内妊娠的继续存活。     

3种保守方式治疗输卵管妊娠的疗效及预后

目的探讨3种保守治疗方法治疗输卵管妊娠的疗效及对患者预后的影响。方法回顾性分析189例年龄〈35岁,有生育要求的输卵管妊娠患者的临床资料,其中43例行腹腔镜下输卵管取胚术,再予MTX 20mg输卵管局部注射（腹腔镜联合药物组,G1）;69例行单纯腹腔镜下输卵管取胚术（腹腔镜组,G2）;77例行药物MTX（50mg／m^2）单次肌肉注射（药物组．G3）。观察3组治疗后持续性异位妊娠发生情况及患侧输卵管通畅情况,比较3组2年内宫内妊娠、重复异位妊娠、继发不孕情况以及宫内妊娠后早期流产发生率。结果3组持续性异位妊娠发生率明显不同,差异有统计学意义,最高为G3组（28．9％）,G2组次之（8．7％）,G1组无1例发生,但两手术组比较差异无统计学意义。3组治疗后患侧输卵管通畅情况提示两手术组通畅率明显高于药物组,差异有统计学意义,G1、G2组比较差异无统计学意义。治疗后随访2年3组的宫内妊娠率、重复异位妊娠率及继发不孕率差异均无统计学意义;两手术组的宫内妊娠率高于G3组,重复异位妊娠率及继发不孕率低于G3组,差异有统计学意义;宫内妊娠后的自然流产率3组比较差异无统计学意义。结论对于有生育要求的年轻输卵管妊娠患者,腹腔镜下保留输卵管手术是首选的治疗方式,其疗效确切,副作用小,对术后生育能力的保护较好。