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.     

子宫角部妊娠的诊断治疗及误诊分析

目的探讨子宫角部妊娠的诊断和治疗。方法对本医院妇产科于2004年1月至2009年2月收治的42例角部妊娠进行回顾性分析。结果首次诊断为角部妊娠或异位妊娠者18例,占42.9%;首次误诊之后得以纠正或意外发现者24例,占57.1%。在B超及内镜监视下行刮宫术成功9例,占21.4%;腹腔镜下角部切开胚胎取出术26例,占61.9%,孕周均小于10周;经腹角部切开病灶清除术或角部楔型切除+同侧输卵管切除术7例,占16.7%,孕周均大于10周。结论子宫角部妊娠的早期诊断率尚待提高。对部分病例可在B超或内镜监视下行刮宫术,孕周小于10周可行腹腔镜手术。     

甲氨蝶呤+米非司酮+中药保守治疗异位妊娠60例临床观察

目的 观察甲氨蝶呤+米非司酮+中药保守治疗异位妊娠的临床疗效.方法 对确诊为异位妊娠并有保守治疗指征和要求的患者60例给予甲氨蝶呤+米非司酮+中药治疗.结果 51例患者血HCG值降至正常,包块全部消失,8例患者因用药后输卵管妊娠破裂而改行腹腔镜下输卵管切除术,1例出现胎心管搏动行腹腔镜下输卵管开窗取胚术.结论 甲氨蝶呤+米非司酮+中药多药联合用于保守治疗宫外孕安全、有效、经济、可靠.     

腹腔镜下输卵管妊娠手术治疗80例临床分析

目的 探讨腹腔镜下异位妊娠的手术方法、适应证、手术疗效及临床应用价值。方法 回顾分析确诊为输卵管妊娠、有手术指征的80例患者的腹腔镜手术情况和术后情况。结果 80例输卵管妊娠均在腹腔镜下完成，术中出血量为5-200ml，手术获得满意疗效。结论 腹腔镜手术具有创伤小、恢复快、术中出血少、住院时间短等优点，是治疗异位妊娠首选的手术方式。     

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。     

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。     

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。     

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。     

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。     

辅助生殖技术后发生宫内外同时妊娠的相关因素分析

目的探讨辅助生殖技术后发生宫内外同时妊娠的高危因素、诊断、治疗及预后。方法对2005年1月～2008年10在广州医学院第三附属医院生殖科进行辅助生殖治疗后发生的7例宫内外同时妊娠病例进行回顾性分析。结果宫内外妊娠的发生率为0.6%,5例为输卵管因素不孕,其中1例有既往异位妊娠史。6例经B超确诊,1例经手术确诊。1例行阴道B超引导下异位孕囊穿刺抽吸胚芽术,1例行输卵管切开取胚术,5例行输卵管切除术,其中3例在异位病灶去除后继续宫内妊娠并分娩活婴。结论既往输卵管盆腔疾病或手术、异位妊娠史是辅助生殖技术后发生宫内外同时妊娠的高危因素。对有高危因素的患者早期加强B超检测有助于早期诊断、早期治疗,将对宫内妊娠的影响减到最小。     

Laparoscopic salpingotomy for tubal pregnancy: comparison of linear salpingotomy with and without suturing

BACKGROUND: The study was carried out to clarify the incidence of post-operative tubal adhesions, patency rate and pregnancy outcome after laparoscopic salpingotomy with and without suturing for tubal pregnancy. METHODS: From May 1996 to December 2002, a total of 97 cases of tubal pregnancy were treated in our centre by laparoscopic conservative surgery. The successful salpingotomy cases were randomly assigned to undergo salpingotomy without suturing (group I; n = 43) or with suturing (group II; n = 32). We compared these patients and assessed their surgical and pregnancy outcome by second look laparoscopy (SLL) 3 months after the first operation. RESULTS: Seventy-five cases (77%) were treated successfully by salpingotomy at initial laparoscopic surgery, and the remaining 22 cases were unsuccessful because of bleeding or complete tubal damage. Pelvic findings were assessed at SLL in 21 of 43 cases (49%) in group I and 17 of 32 (53%) in group II. There were no significant differences in gestational age, ectopic site, tubal diameter, tubal condition, intraperitoneal haemorrhage and pre-operative HCG levels between the two groups. Only the operation time was longer in group II than in group I (91 +/- 15 versus 69 +/- 15 min, P < 0.05). The tubal patency rate of the treated side was 90% (19/21) in group I and 94% (16/17) in group II. Also the peritubal adhesions were observed in 33% (7/21) in group I and 29% (5/17) in group II, and were mostly comprised of filmy adhesions. A tubal fistula occurred in two cases in each group. Pregnancy rate was 79% (15/19) in group I and 92% (12/13) in group II, and this did not reveal any significant difference of cumulative pregnancy rate between the groups. CONCLUSION: We recommend laparoscopic linear salpingotomy as a useful method in the management of cases with tubal pregnancy who desire future pregnancy. This preliminary study emphasizes that the procedure involving suturing has no additional benefit over the non-suturing technique during salpingotomy.     

腹腔镜诊治不孕症患者盆腔病变临床分析

目的探讨应用腹腔镜手术诊治不孕症的临床价值。方法对126例女性不孕症患者行腹腔镜诊断和治疗,观察术后妊娠率。结果 126例中发现盆腔病变117例,占92.86%;慢性盆腔炎是不孕症的第1位病因;其次为子宫内膜异位症、多囊卵巢综合征。腹腔镜手术术后妊娠率为47.50%,1例发生异位妊娠。结论腹腔镜手术对女性不孕症盆腔病变的诊治具有重要的价值。     

Over-diagnosis of hydatidiform mole in early tubal ectopic pregnancy

AIMS: Tubal ectopic hydatidiform moles are rare lesions, and only 40 cases have been reported in the world literature. We investigated the apparently high incidence of tubal ectopic hydatidiform moles in women referred for treatment to a Supraregional Trophoblastic Tumour Screening and Treatment Centre between 1986 and 1996. METHODS AND RESULTS: Of 4261 women referred during the study period, 25 (0.6%) had a suspected tubal ectopic hydatidiform mole and paraffin-embedded tissue was available in 20 (80%) of these. Each case was reviewed by two pathologists and DNA flow cytometric analysis was undertaken when the histological diagnosis was initially deemed equivocal or suggestive of hydatidiform mole. On review, 17 cases (85%) showed no evidence of hydatidiform mole (circumferential trophoblastic proliferation, hydrops, scalloped villi, and stromal karyorrhexis). Of these, 11 cases (65%) showed features of early placentation and six (35%) showed hydropic abortion. DNA flow cytometry was performed in 14 (82%) of these cases and revealed a diploid population in each case. Three cases of molar pregnancy (15%) were identified. Each of these cases had the histological features of an early complete hydatidiform mole. Sufficient tissue was available for DNA flow cytometric analysis in two of these cases and confirmed the presence of diploidy in each. CONCLUSION: Our results show that tubal ectopic hydatidiform mole is a rare entity and demonstrate that it is over-diagnosed. Polar trophoblastic proliferation and hydropic villi are features of early placentation and of hydropic abortion. Sheets of extravillous trophoblast may be particularly prominent in tubal ectopic gestation. In the absence of circumferential trophoblastic proliferation combined with hydropic change a diagnosis of gestational trophoblastic disease should be avoided.     

Laparoscopic fimbrioplasty: an evaluation of 35 cases

The aim of this prospective study was to assess the value of laparoscopic treatment of severe fimbrial occlusions. During a period of 52 months infertile patients with fimbrial lesions were treated by operative laparoscopy. Only those patients requiring incision of the tubal serosa (salpingostomy) were included, representing the most severe lesions. The most frequent cases, those patients requiring simple adhesiolysis and deagglutination of the fringes, were excluded. All tubal lesions were documented carefully. Positive Chlamydia trachomatis (CT) serology was found in 65.7% of the patients. All the patients were followed up for at least 2 years. Three patients lost to follow-up were defined as failures. The global conception rate was 74.3%. The intrauterine pregnancy rate was 51.4%, and the 'take home baby rate' was 37.1% (only the first pregnancy being taken into account). The ectopic pregnancy rate was 22.9%. A positive CT serology was found to have a significant influence on the outcome. It can be concluded that the laparoscopic approach provides results similar to those obtained by microsurgery for the treatment of severe fimbrial occlusions, and represents an acceptable alternative to in-vitro fertilization (IVF) in selected cases.      

紧急避孕后异位妊娠33例分析

目的探讨口服紧急避孕药与异位妊娠的相关性。方法对我院2006～2008年收治口服紧急避孕药后异位妊娠患者33例进行了回顾性分析与总结。结果 33例异位妊娠中服用左炔诺孕酮30例,服用米非司酮3例。异位妊娠流产型居多,占69.70%,非手术治疗治愈率达到51.52%。结论异位妊娠的发生可能与服用紧急避孕药后输卵管功能障碍,导致胚胎异常植入有关;非手术治疗治愈率较高可能与异位妊娠流产型居多相关;口服紧急避孕药后应重视阴道流血症状,警惕异位妊娠,防止误诊误治。     

Blind hemivagina: long-term follow-up and reproductive performance in 42 cases.

Our purpose was to analyse the reproductive performance of women with obstructed hemivagina after surgical treatment. After laparoscopic exploration of 42 cases (mean age: 18 years), didelphic and complete septate uterus were found in 78 and 22% of cases respectively. Resection of vaginal septum and hemihysterectomy with ipsilateral hemicolpectomy were performed in 88% and 12% of the cases, respectively, between 1970 and 1997. Long-term results were assessed by a questionnaire and obtained for 38 patients (mean years after treatment and range: 6.5; 1-23). Dysmenorrhoea and abdominal pain were resolved in 87% and 100% of the cases, respectively. Nine patients experienced 20 pregnancies (13 living children, four early spontaneous abortions, two early terminations and one ectopic pregnancy). Nine offspring (69% of live births) were delivered after 37 weeks. Four patients had four pregnancies ipsilateral to blind hemivagina after vaginal septum resection (two living children, one early spontaneous abortion and one ectopic pregnancy). These results suggest that laparoscopic exploration and resection of vaginal septum are the appropriate treatments for obstructed hemivagina. Subsequent reproductive performance was comparable to that reported following treatment of the associated uterine malformation.     

Heterotopic pregnancy in a large inner-city hospital: a report of two cases

While ectopic pregnancy is a common occurrence, especially in the nonwhite female patient population, heterotopic pregnancy has traditionally been regarded as a rare clinical event until recently, especially with the advent of assisted reproductive procedures. We reported two cases, one in which an intrauterine pregnancy was discovered after a diagnosis of tubal abortion, another in which a patient underwent laparotomy for a tubal ectopic pregnancy with a concomitant previously diagnosed intrauterine pregnancy. The first patient subsequently delivered at term, while the second was lost to follow-up. In both cases, there was a delay in detecting the ectopic pregnancy component. These cases suggest that the clinician maintain a reasonable index of suspicion while evaluating a patient presenting with pelvic pain in the face of a documented intrauterine pregnancy. They also demonstrate the need for prompt and immediate action at the first sign indicating ectopic pregnancy to avoid missing this potentially life-threatening condition.     

输卵管积水患者在胚胎解冻周期三种治疗方法的研究

目的探讨输卵管积水患者在胚胎解冻移植(FET)周期中的最佳治疗方案。方法对输卵管积水致不孕而接受体外受精-胚胎移植(IVF-ET)未妊娠而且有冷冻胚胎的患者91例,分为三组:A组,采用积水输卵管切除术30例;B组,采用体外短波治疗加经阴道抽吸输卵管积水31例;C组,仅采取体外短波治疗30例。比较患者FET的胚胎种植率、临床妊娠率、妊娠后的早期流产率和异位妊娠发生率。结果A组的胚胎种植率、临床妊娠率、早期流产率、异位妊娠发生率分别为14.8%,36.7%,18.2%,0。B组的分别为16.3%,38.7%,16.7%,8.3%。C组的分别为11.2%,26.7%,25%,12.5%。A,B组之间胚胎种植率、临床妊娠率、早期流产率的比较差异均无显著性,异位妊娠发生率的比较差异有显著性。A,B组与C组之间临床妊娠率、早期流产率的比较差异有显著性。结论输卵管积水患者在FET前行输卵管切除术或者用体外短波治疗加经阴道抽吸输卵管积水可以改善其FET结局。