腹腔镜在异位妊娠诊治中的价值

目的 探讨腹腔镜手术在异位妊娠诊断和治疗中的价值。方法 2003年1月～2005年1月，我院对342例临床拟诊异位妊娠行腹腔镜检查。诊断明确335例，行单侧输卵管切除术、输卵管开窗术、部分卵巢切除术或宫角切除术等：诊断不明确7例，进一步行诊断性刮宫术。结果 335例腹腔镜确诊异位妊娠，333例成功行腹腔镜手术（包括3例卵巢妊娠、3例输卵管间质部妊娠），2例中转开腹。7例腹腔镜未见明显妊娠部位行诊断性刮宫术，其中1例子宫畸形（残角子宫）合并宫内妊娠行残角子宫及同侧输卵管切除术，1例卵巢黄体囊肿破裂合并宫内妊娠行黄体囊肿剥出术，5例宫内外均未发现妊娠部位，MTX治疗成功。340例腹腔镜术后8～24h肛门排气，除5例MTX保守治疗外，335例术后2～4d出院；2例中转开腹术后24～36h肛门排气，术后6d出院。结论 腹腔镜检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、恢复快。

Use 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 342 cases suspected of having ectopic pregnancy.If the confirmative diagnosis was clarified,unilateral salpingectomy,salpingostomy,ovarian wedge resection,or cornual resection were conducted;if the diagnosis was not clearly established under laparoscope,further evaluation with dilation and curettage was given.Results Out of 342 cases,335 were confirmatively diagnosed as having ectopic pregnancy under laparoscope,333 of which were successfully treated by laparoscopy(including 3 cases of ovarian pregnancy and 3 cases of interstitial pregnancy) and 2 of which were given conversions to open surgery.Among 7 cases in which the diagnosis was not clearly established under laparoscope,1 case was diagnosed as having intrauterine pregnancy with uterine anomaly(unicornuate uteri with rudimentary horn) and was treated with cornual resection and homolateral salpingectomy,1 case was diagnosed as having intrauterine pregnancy accompanying corpus luteal rupture and was treated with enucleation of corpus lutein cyst,and other 5 cases were not found having intrauterine or ectopic pregnancy and were cured with MTX injection.The time to first flatus was 8~24 hours after laparoscopic operation in 340 cases and 24~36 hours after open surgery in 2 cases.The duration of postoperative hospital stay was 2~4 days after laparoscopy except for 5 cases of MTX therapy,and 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.