腹腔镜诊治异位妊娠1082例

目的:探讨腹腔镜手术在异位妊娠诊治中的价值。方法:对2002年4月～2007年4月在我院行腹腔镜诊治的异位妊娠1082例进行回顾性分析。结果:1078例在腹腔镜下明确诊断并完成手术,行输卵管保守性手术694例,输卵管切除374例,卵巢妊娠物清除术11例,宫角切除术11例。诊断不明确4例,术后病理证实宫内早孕2例。发生持续性异位妊娠4例,其中1例追踪病理证实为癌变。无1例中转开腹。手术时间保守性手术组(86.8±11.2)min,术中出血量(90.5±18.4)ml;输卵管切除术组(30.5±8.8)min,术中出血量(15.9±5.6)ml。两组术后住院时间4～6天出院。术后监测血β-HCG,输卵管保守性手术血β-HCG转为正常时间为(14±3)天,患侧输卵管切除术(9±2)天,卵巢妊娠物清除术为(8±1)天,宫角切除术为(14±5)天。术后随访493例,随访时间6～18个月,经子宫输卵管碘油造影或通液术示输卵管通畅411例,随访期间自然宫内妊娠233例,妊娠率47.3%(233/493)。结论:腹腔镜有利于诊断早期异位妊娠,同时手术治疗异位妊娠疗效确切、安全、恢复快,属微创手术,应普及推广。

Use of laparoscopy in the diagnosis and treatment of 1082 cases of ectopic pregnancy

Objective:To explore the value of laparoscopy in the diagnosis and treatment of ectopic pregnancy.Methods:1 082 cases of ectopic pregnancy using laparoscopy in the diagnosis and treatment from April 2002 to April 2007 in our hospital were retrospectively analyzed.Results:1 078 cases were confirmatively diagnosed as having ectopic pregnancy and were successfully treated by laparoscopy,694 cases given laparoscopic conservative operation,374 cases given laparoscopic salpingotomy,11 cases given ovarian wedge resection,11 cases given cornual resection were conducted.4 cases in which the diagnosis was not clearly established under laparoscope,2 of which were diagnosed as having intrauterine pregnancy.4 cases had persistent ectopic pregnancy,one of which was proved to be cancerous by pathological track.None of them conversed to open.The surgical time was(86.8±11.2)min in the conservative operation group and(30.5±8.8)min in the salpingectomy group.The intraoperative blood loss was(90.5±18.4)ml in the conservative operation group and(15.9±5.6)ml in the salpingectomy group.The two groups discharged in 4 to 6 days after operation.The postoperative time to normal serum β-HCG levels was(14±3)d in the conservative group and(9±2)d in the salpingectomy group,(8±8)d in ovarian wedge resection group,(14±5)d in cornual resection group.A follow-up was carried out in 493 patients,hydrotubation or salpingography revealed patent oviduct in 411 patients,during the follow-up period,233 patients were intrauterine pregnancy and the pregnancy rate was 47.3%(233/493).Conclusion:Laparoscopy is valuable in the early diagnosis of ectopic pregnancy,laparoscopic operation is effective and safe in the treatment of ectopic pregnancy,it is a minimally invasive surgery,should be promote universal.