腹腔镜与开腹手术早期诊治特殊部位异位妊娠的比较

目的探讨腹腔镜诊断及治疗特殊部位异位妊娠的价值。方法回顾分析2000年1月～2009年12月76例特殊部位异位妊娠患者的临床资料,其中卵巢妊娠41例,宫角妊娠18例,腹腔妊娠5例,输卵管残端妊娠3例,子宫残角妊娠8例,阔韧带妊娠1例。腹腔镜手术36例,开腹手术40例。对比分析2组围术期情况。结果特殊部位异位妊娠(76例)占同期异位妊娠(2228例)的3.4%。腹腔镜手术成功32例,成功率88.9%,中转开腹4例,无术中、术后并发症发生。腹腔镜组手术时间、术后住院时间与开腹组差异无显著性(P0.05),术中出血量[(18.2±4.3)mlvs(52.7±25.6)ml,t=7.53,P=0.00]和术后病率[56.3%(18/32)vs85.0%(34/40),χ2=7.32,P=0.01]均明显低于开腹组。结论腹腔镜用于早期诊断及治疗特殊部位异位妊娠安全可行。

Comparison of Laparoscopy and Laparotomy in the Early Diagnosis and Treatment of Ectopic Pregnancy at Special Sites

Objective To investigate the value of laparoscopy in the early diagnosis and treatment of ectopic pregnancy at special sites.Methods Data of 76 patients suffered from ectopic pregnancies at special sites,who were diagnosed and treated by laparoscopy（36 cases）or laparotomy（40 cases）from January 2000 to December 2009,were retrospectively analyzed.The sites of ectopic pregnancies included the ovary in 41,uterine horn in 18,abdominal cavity in 5,remnant oviduct in 3,rudimentary horn in 8,and broad ligament in 1.Of these cases,36 patients received laparoscopy and 40 underwent laparotomy.Results The incidence of ectopic pregnancy at special sites accounted for 3.4% of all the patients（totally 2228 cases）.In the laparoscopy group,the surgery was completed successfully in 88.9%（32 cases）of the patients,4 patients were converted to open surgery,none of this group showed complications during and after the operation.No significant difference in the operation time and postoperative hospital stay was detected between the two groups（P0.05）.Whereas,the intraoperative blood loss and postoperative morbidity in the laparoscopy group were significantly lower than those in the laparotomy group [（18.2±4.3）ml vs（52.7±25.6）ml,t=7.53,P=0.00;and 56.3%（18/32）vs 85.0%（34/40）,χ2=7.32,P=0.01].Conclusions Laparoscopy is safe and feasible for the early diagnosis and treatment of ectopic pregnancies at special sites.