腹腔镜早期诊治可疑异位妊娠的临床意义

目的 评估可疑异位妊娠(ectopic pregrnancy，EP)患者腹腔镜(laparoscopy，LSC)早期诊断和急诊手术的临床价值。方法 回顾分析1998年8月至2003年8月收治的经LSC手术治疗的可疑EP患者186例，均在入院24h内接受急诊LSC手术。结果 185例手术经腹腔镜完成，l例中转开腹，均无并发症发生。术中诊断EP172例(均经病理证实)，术前诊断符合率92．5％；其余病例依次为卵巢囊肿9例(4．8％)，宫内妊娠黄体破裂5例(2．7％)。32例合并不孕患者中25例有盆腔粘连，17例有输卵管卵巢病变，均行相应处理。12例少见异位妊娠(包括4例输卵管间质部妊娠，4例卵巢妊娠，3例腹腔妊娠，l例子宫肌壁间妊娠)，15例休克型异位妊娠，经腹腔镜手术亦获满意治疗效果。结论 急诊LSC手术不仅可早期确诊可疑EP患者，为保守性治疗赢得时间，而且还可同时对不孕症患者进行诊治。急诊LSC手术治疗休克型及少见异位妊娠亦是可行且安全的。

Clinical significance of early diagnosis and therapy of suspicious ectopic pregnancy by laparoscopy

Objective To evaluate the clinical value of early diagnosis and emergency operation of suspicious ectopic pregnancy (EP) by laparoscopy.Methods The clinical data of 186 suspicious EP patients who had received laparoscopic operation in our hospital during August 1998 to August 2003 were reviewed.All cases received emergency laparoscopic operation within 24 hours after admission.Results The operation was performed on 185 cases by LSC without complications,only 1 case was transferred to traditional surgery during the operation.EP was diagnosed in 172 cases during operation (with pathologic proof,the coincidence rate with preoperational diagnosis being 92 5%;other cases were:9(4 8%)cases of ovarian cyst,5(2 7%)intrauterine pregnancy complicated with luteal rupture.Of 32 patients with infertility,25 cases had pelvic adhesion and 17 had tube or ovarian lesions and received proper treatment.In 12 cases with rarely seen ectopic pregnancies (including 4 interstitial pregnancy,4 ovarian pregnancy,3 abdominal pregnancy and 1 intramural pregnancy) and 15 cases with ectopic pregnancy with hypovolemic shock,the laparoscopic operation was also effective.Conclusion The emergency laparoscopic operation can early diagnose EP to gain time for conservative therapy,and it can also diagnose and treat infertility.It is feasible and safe for EP with hypovolemic shock or rare EP.