异位妊娠腹腔镜手术及引流的选择

The Management of Abdominal Dr ai nage in Laparoscopic Surgery of Ectopic Pre gnancy

目的 :总结腹腔镜治疗异位妊娠术式及放置引流的选择。方法 :异位妊娠患者 6 3例 ,其中 32例在腹腔镜下行输卵管线形切开取胚术 ,另 31例行输卵管切除术。按引流的方式不同分为 3个小组 ,分别给予直径 10mm单腔管引流、5mm引流袋管引流和不放引流。术后统计手术时间、术后住院日、引流量、拔除引流管时间、体温、疼痛感、肛门排气时间和穿刺孔渗液的情况。结果 :切除组手术时间平均为 30分钟 ,术后平均住院时间 3天 ,引流量平均 10 0± 80ml,拔除引流管时间平均 12± 10小时 ;而取胚组则分别为 5 0分钟 ,4 .5天、2 0 0± 15 0ml、2 0± 12小时。切除组仅 2例未放置引流管者出现穿刺孔渗液 ,取胚组未放引流管者术后 36小时均有穿刺孔渗液 ,放置单腔管引流者 ,穿刺孔渗液发生率明显低于引流袋管引流者。结论 :异位妊娠腹腔镜手术治疗具有安全、微创、快捷的特点。无再生育要求者 ,最好行输卵管切除 ,此术式腹腔渗出不多。若要保留生育功能而行线形切开取胚术者 ,应置管充分引流。

Objective: To investigate the result of laparoscopic s urgery in women with ectopic pr egnancy after di fferent management of abdominal drainage. Methods: 63 cases of women suffering from ectopic pr egnancy and undergoing laparosc opic either salpingectomy (SE) or salpingo tomy (SO) were taken into three groups . Group one was drained with φ10 mm rubber d rain tube, group two was drained wi th φ 5mm plastic tube, and group three had n o drainage. In-hospital time after operation, amount of drain, time before dra in removed, body temperature , pain, exudation from Trocar hole and inte stines recovery time were recorded.Results: Avera ge operation time was 30 min in SE group, an d 50min in SO group.The average in-hosp ital time after operation was 3 days and 4.5 days in SE group and SO group. The amount of exudation from Trocar hole was 10 0±80 ml and 200±150 ml in SE group an d SO group,respectively. In those without drain, two cases (2/17) in SE group and 3 cases(3/6) in SO group were found to he exuding from Trocar hole. Conclusions:La paroscopic surgery was a safe and convenient method fo r therapy of ectopic pregnancy. In those withoutwho doesn't exp ected for fertility expectiation, Salping ectomy may be most suitable, which can redu ce exudations in side abdominal cavity. For those who ex pected for keeping fertility, salpingotom y may be a ppropriate, and should be drained sufficie ntly.