腹腔镜治疗异位妊娠306例临床分析

目的了解异位妊娠的临床特点,总结异位妊娠的相关病因学和腹腔镜术中所见特点,探讨腹腔镜手术在异位妊娠诊治中的可行性、安全性及治疗效果。方法回顾性分析2007年3月～2009年3月在同济医院行腹腔镜手术治疗的306例异位妊娠患者的流行病学资料、手术方法和术中所见。结果所有患者均接受了腹腔镜检查及治疗,其中腹腔镜下患侧输卵管切除术186例,占60.78%;保留输卵管手术（保守手术）120例,占39.22%。1例患者因腹腔粘连严重而中转开腹,余305例均成功经腹腔镜手术。腹腔镜手术术中发现异位妊娠不同比例地合并子宫内膜异位症、生殖器官畸形、盆腔结核、盆腔炎及手术后瘢痕粘连。术后无持续性异位妊娠,出血并发症发生率为0.83%。结论异位妊娠发生率上升与人工流产、剖宫产率增高、盆腔感染、盆腔手术史、合并盆腔内膜异位症等高危因素有关。腹腔镜手术治疗妇科异位妊娠快速、安全、有效,故可作为一种常规手术加以推广。

Clinical analysis of 306 cases of ectopic pregnancy treated with laparoscopy

Objective To investigate the clinical character of ectopic pregnancy, and discuss the safety, effect and availability of treatment of ectopic pregnancy with laparoscopy. Methods The epidemiological data, operating method and findings in operation of 306 cases of ectopic pregnancy treated with laparoscopy were retrospectively analyzed. Results Nearly all operations were accomplished with laparoscopy smoothly without complications except one case which undergoing laparotomy for conglutination. No persistent ectopic pregnancy occurred in all cases. The incidence of postoperative bleeding complication was 0.83%. Conclusion Induced abortion, uterine-incision delivery, pelvic inflammation, pelvic operation history and endometriosis are all involved in ectopic pregnancy. Treating the ectopic pregnancy with laparoscope is safe, effective and quick, and can be suggested as the regular operation.