腹腔镜下治疗休克型输卵管妊娠的临床观察

目的　探讨腹腔镜手术治疗休克型异位妊娠的可行性与安全性。方法　回顾性分析我院 1996年 1月至 2 0 0 1年 1月 5年间收治的经腹腔镜手术治疗的输卵管妊娠病例 2 15例的临床资料。其中有休克症状及腹腔内出血量超过 10 0 0ml的 2 1例为研究组 ,其余 194例为对照组 ,分析两组患者围手术期情况。结果　研究组与对照组的一般情况无明显差异 ;输卵管破裂的发生率分别为 81%(17/2 1)、16% (3 1/194) ,两组比较 ,差异有极显著性 (P <0 0 1) ;腹腔内出血量分别为 (1775± 5 3 1)与(13 3± 176)ml (P <0 0 1) ,自体输血量分别为 (1141± 13 2 7)与 (2 5± 83 )ml (P <0 0 1) ,自体输血率分别为 95 %与 9% ,两组比较 ,差异均有极显著性 (P <0 0 1) ;术中出血量分别为 (40± 2 2 )与 (5 6±5 8)ml,两组比较 ,差异无显著性 (P >0 0 5 )。研究组与对照组输卵管切除术的比例分别为 86%与5 1% ,两组比较 ,差异有极显著性 (P <0 0 1) ;手术时间分别为 (5 0± 2 4)与 (43± 2 4)min ,两组比较 ,差异无显著性 (P >0 0 5 ) ;术后住院时间分别为 (3 0± 0 8)与 (2 3± 0 8)d ,两组比较 ,差异无显著性 (P>0 0 5 )。两组均无腹腔镜操作引起的围手术期并发症。结论　具备熟练的腹腔镜操作技术对休克型输卵管妊娠

Laparoscopic surgery in patients with hypovolemic shock due to ectopic pregnancy

OBJECTIVE: To evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock. METHODS: Two hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. These patients were divided into two groups. Group I included 21 patients of ectopic pregnancy with shock and intraperitoneal hemorrhage more than 1,000 ml, and group II included 194 hemodynamically stable patients with blood loss less than 1,000 ml. The clinical data of perioperative periods in two groups were analyzed. RESULTS: All patients were tube pregnancies. The rate of tube rupture was higher in group I than that in group II (81% versus 16%), the difference was statistically significant (P < 0.01). Intraabdominal blood loss was significantly higher in group I (1,775 +/- 531) ml than that in group II (133 +/- 176) ml, autologous blood transfusions were given to 95% and 9% of patients in group I and II respectively (P < 0.01). Laparoscopic salpingectomy was performed to 86% and 51% of patients in group I and II, the difference was significant. The operating time was longer in group I than in group II (50 +/- 24) and (43 +/- 24) min, but the difference was not significant. All patients had no perioperative complications. CONCLUSIONS: Operative laparoscopy in patients with hypovolemic shock can be safely and effectively performed by experienced laparoscopists with the aid of optimal anesthesia, advanced cardiovascular monitoring and autologous blood transfusion.