腹腔镜手术治疗输卵管妊娠中2种止血方法的比较

目的 探讨腹腔镜下输卵管妊娠保守手术不同止血方式对输卵管通畅情况的影响.方法 2009年9月~2011年1月对64例输卵管妊娠且要求保留输卵管,以抽签方法分为丝线阻断组（n=32）及非丝线阻断组（n=32）.丝线阻断组先用7-0丝线在病灶与子宫之间结扎进行预处理后再行输卵管妊娠部位中央最薄弱区域切开取胚术;非丝线阻断组不用丝线结扎,直接在输卵管妊娠部位中央最薄弱区域切开取胚术和电凝止血.如果术中出血较多而止血困难行输卵管切除.比较2组手术时间、术中出血量、术后β-hCG降至正常的时间和输卵管通畅情况.结果 丝线阻断组手术时间（30.5±0.3）min,显著短于非丝线阻断组（35.4±5.5）min（t=-5.032,P=0.000）;丝线阻断组术中出血量（20.5±0.3）ml,显著少于非丝线阻断组（45.2±0.9）ml（t=-147.282,P=0.000）;丝线阻断组术后β-hCG降至正常的时间（20±4）d显著短于非丝线阻断组（30±5）d（t=-8.835,P=0.000）.丝线阻断组术后患侧输卵管通畅率68.8%（22/32）,明显高于非丝线阻断组34.5%（10/29）（χ2=12.430,P=0.002）.丝线阻断组无一例发生输卵管完全梗阻或切除;非丝线阻断组发生8例输卵管完全梗阻,3例切除输卵管.2组均无持续性异位妊娠发生.结论 在腹腔镜输卵管切开取胚术中,预先应用7-0丝线在病灶与子宫之间结扎止血效果显著,减少术中出血量,减少电凝对输卵管黏膜的损伤,保持输卵管通畅,有利于保护患者的生育功能,值得推广.

Comparison of Two Hemostasis Methods in Laparoscopic Surgery for Tubal Pregnancy

Objective To discuss the impact of two hemostasis methods on tubal patency in laparoscopic surgery for tubal pregnancy. Methods A total of 64 cases of tubal pregnancy with request for fallopian tube preservation were randomly divided into silk block group and none-silk block group, with 32 patients in each group. We ligated between lesions and uterine with 7-0 silk for pretreatment followed by embryo operation in the central weakest area of tubal pregnancy section in the silk block group; we directly removed the embryo in the central weakest area of tubal pregnancy section and conducted electric coagulation hemostasis in the non-silk block group. The oviduct would be resected if heavy blood loss leading to difficult hemostasis. The operative time, intraoperative blood loss, the time for ~-hCG dropping to normal and tubal patency were compared between the two groups. Results The operative time of the silk block group was （30.5 ± 0.3 ） min, significantly shorter than that of the none-silk block group （35.4 ± 5.5 ） min, t = -5. 032 ,P = 0. 000 ] ;the blood loss of the silk block group was （20.5 ± 0.3 ） ml, significantly less than that of the none-silk block group （45.2 ± 0.9） ml, t = - 147. 282, P = 0. 000 ] ; the time for 13-hCG dropping to normal was（20 ± 4）d, significantly shorter than that of the none-silk block group （30 ± 5 ） d, t = - 8. 835,P = 0. 000 ] ; the postoperative tubal patency rate of the silk block group was 68.8% （22/32）, significantly higher than that of the none-silk block group 34.5 % （ 10/29）, X2 = 12. 430, P = 0. 003 ]. No fallopian tube obstruction or resection occurred in the silk block group, while there were 8 cases of fallopian tube complete obstruction and 3 cases of fallopian tube resection in the none-silk block group. No persistent ectopic pregnancy occurred in both groups. Conclusion Intraoperative prior application of 7-0 silk ligation between lesions and uterus reduces intraoperative blood loss and the damage to tubal mucosa to maintain tubal potency, therefore, patients＇ fertility is better preserved.