探讨腹腔镜手术诊治异位妊娠的价值

目的:探讨腹腔镜手术诊断和治疗异位妊娠的应用价值。方法:2004年1月至2008年12月我院为226例拟诊为异位妊娠的患者行腹腔镜探查,明确诊断223例,同时行单侧输卵管切除术,输卵管开窗术及宫角切除术;诊断不明确3例,进一步行诊刮术。结果:223例经腹腔镜探查确诊为异位妊娠,221例成功行腹腔镜手术,2例中转开腹。3例腹腔镜下未见明显妊娠部位而行诊刮术,其中1例卵巢黄体破裂合并宫内妊娠行黄体囊肿剥除术,2例宫内宫外未见妊娠部位,注射MTX治疗成功。224例腹腔镜术后6～24h肛门排气,除2例用MTX保守治疗外,222例术后4d出院,2例中转开腹者术后24～36h肛门排气,术后5～6d出院。结论:腹腔镜探查有利于异位妊娠的早期诊断,腹腔镜手术治疗异位妊娠安全、有效、康复快。

Value of laparoscopy in the diagnosis and treatment of ectopic pregnancy

Objective:To explore the value of laparoscopy in the diagnosis and treatment of ectopic pregnancy.Methods:Laparoscopy was performed in 226 cases suspected of having ectopic pregnancy from Jan.2004 to Dec.2008.The confirmative diagnosis of 223 cases was clarified,unilateral salpingectomy,salpingostomy,or cornual resection were conducted.The diagnosis of 3 cases was not clearly established under laparoscope,further evaluation with diagnostic curettage was given.Results:Out of 226 cases,223 were confirmatively diagnosed as ectopic pregnancy under laparoscopy,221 of which were successfully treated by laparoscopy and 2 of which were given conversion to open surgery.Among 3 cases in which the diagnosis was not clearly established under laparoscopy were treated by diagnostic curettage,1 case was diagnosed as intrauterine pregnancy accompanying corpus luteum rupture and was treated with enucleation of corpus luteum cyst and other 2 cases were not found having intrauterine or ectopic pregnancy and were cured with MTX injection.The time to first flatus was 6-24h after laparoscopic operation in 224 cases and 24-36h after open surgery in 2 cases.The duration of postoperative hospital stay was 4 days after laparoscopy except for 2 cases of MTX therapy,and 5-6 days after open surgery.Conclusions:Laparoscopy is valuable in the early diagnosis of ectopic pregnancy,laparoscopic operation is safe and effective in the treatment of ectopic pregnancy,and patients recovered quickly.