腹腔镜输卵管妊娠保守性手术42例分析

目的:探讨腹腔镜输卵管妊娠保守性手术的指征及影响手术效果的因素。方法:对我院2004年5月1日~2006年6月1日收治的42例腹腔镜输卵管妊娠保守性手术患者的临床资料进行回顾性分析。结果:42例输卵管妊娠均经病理证实。术前血β-HCG≤2000mIU/ml35例,β-HCG>2000mIU/ml7例,两组手术时间、术中出血量存在显著性差异(P<0.05)。超声测量妊娠包块直径≤3cm33例,包块直径>3cm9例,两组在手术时间及术中出血量方面也存在明显差异(P<0.05)。腹腔积血量对手术无影响。行输卵管造口术41例,其中6例行缝合术,伞端妊娠组织挤出术1例。术后1个月,行输卵管造影18例,通畅16例。18例妊娠,再次患侧异位妊娠4例,妊娠率及异位妊娠率分别是42.86%,9.52%。结论:腹腔镜输卵管妊娠保守性手术选择血β-HCG≤2000mIU/ml、妊娠包块直径≤3cm的病例,是一种安全、有效、微创的手术方法。

Analysis on laparoscope conservative operation of 42 cases with tubal pregnancy

Objective:To investigate the indications and factors related to the conservative operative efficacy of laparoscopy on tubal pregnancy.Methods:From May 1,2004 to June 1, 2006, 42 cases with tubal pregnancy underwent laparoscopic conservative operation were retrospectively analyzed.Results:42 cases were identified by pathology.35 patients had lower β-HCG which serum level were ≤2 000 mIU/ml ,7 patients had upper β-HCG which serum level >2 000 mIU/ml . The mean time of operation was longer and the mean blood loss was more when β-HCG was higher than 2000 mIU/ml (P<0.05) . There were 9 cases which had larger ultrasonographic measurement of entopic size and the mean dimension was more than 3 cm.The entopic size of 33 cases was ≤3 cm . The operative time and blood loss were significantly different in the two groups too (P<0.05). The abdominal blood was no effect on operation.41 cases underwent salpingostomy including 6 cases with suturing.1 case underwent fimbrial.1 case of persistent tubal pregnancy was found after salpingostomy salpingostomy.Tuba uterine of 18 patients were visualization by salpingography.16 cases had patent tuba uterine at 1 month after surgery.18 patients had successfully pregnancy including 4 cases with tubal pregnancy in treated side.Pregnancy rate and ectopic pregnancy rate were 42.86 % and 9.52 %, respectively.Conclusion:Laparoscopic salpingotomy is a safe , useful and less invasive technique for future pregnancy.Serum β-HCG level ≤2 000 mIU/ml and tubal ectopic size ≤ 3cm are better indications on patient selection.