不同部位异位妊娠腹腔镜治疗的选择及疗效分析.docVIP

不同部位异位妊娠腹腔镜治疗的选择及疗效分析 　　【摘要】 目的：探讨腹腔镜治疗异位妊娠的适应证、术式、疗效及安全性。方法：选择2008年1月-2013年5月两家医院腹腔镜治疗的异位妊娠309例，麻醉选择气管插管全麻或硬膜外阻滞复合喉罩通气全麻。术式包括输卵管切开取胚术或卵巢妊娠切开取胚术、患侧输卵管切除术、输卵管挤胚术等。结果：腹腔镜异位妊娠保守性手术共267例，包括输卵管妊娠流产型、破裂型、未破裂型及卵巢妊娠。根据术式不同，手术时间5～45 min，术中出血5～80 mL。仅2例发生持续性异位妊娠，经药物保守治疗治愈。结论：腹腔镜治疗异位妊娠损伤小、安全、对腹腔干扰小、术后恢复快，是治疗异位妊娠的理想方法。 　　【关键词】 腹腔镜； 异位妊娠； 持续性异位妊娠； 全身麻醉 　　【Abstract】 Objective： To discuss the indication， surgical method， curative effect， and safety of laparoscopy curing ectopic gestation. Method： We chose 309 cases curing ectopic gestation by laparoscope in two hospitals from Jan. 2008 to May. 2013， and concerning the anesthesia. We chose intubation anesthesia and general anesthesia of laryngeal mask airway complex epidural block. The surgical method included cutting fallopian tube to get the embryo， side salpingectomy and tubal pregnancy embryos extrusion operation. Result： The number of conservative surgery was 267， including tubal abortion， ruptured， unruptuerd type， and ovarian pregnancy. According to different surgeries， the time was usually controlled within 5-45 mins and hemorrhage during operation was usually in between 5 and 80 mL. We only had two cases got persistent ectopic pregnancy and was cured by drug conservative therapeutic. Conclusion： Curing ectopic gestation by laparoscopy has the advantages of little damage to human body， safety， little interference to enterocoelia and quick recovery after surgery which is an ideal method to cure ectopic gestation. 　　【Key words】 Laparoscopy； Ectopic gestation； Persistent ectopic pregnancy； General anesthesia 　　First-author’s address： Shanxi Maternal and Child Care Hospital Technical Collaboration Hospital Xi’an Ci’ai Obstetrics and Gynecology Hospital， Xi’an 710001， China 　　doi：10.3969/j.issn.1674-4985.2014.25.0044 　　异位妊娠是指受精卵在子宫腔以外部位着床发育。异位妊娠按部位可分为输卵管妊娠、宫颈妊娠、卵巢妊娠、腹腔妊娠、阔韧带妊娠等，其中以输卵管妊娠最常见。是妇科常见的急腹症之一，发病率约为1%，虽少数患者早期较难确诊，但延误诊断可危及患者生命[1]。近年来随着生活节奏的加快、生育年龄的增加，其发病率有逐年增加的趋势。本院2008年1月-2013年5月共收治异位妊娠309例，全部应用腹腔镜治疗，现总结如下。