腹腔镜治疗异位妊娠238例临床分析

The Clinical Analysis of 238 Cases of Ecptopic Pregnancy with Treatment of Laparoscopy

目的 探讨腹腔镜下异位妊娠各种处理方式的临床价值。方法 1998- 2 0 0 2年用腹腔镜进行异位妊娠手术 2 38例。保守手术包括局部药物注射、开窗或破裂口取卵 ,开窗取卵后常规给予米非司酮 2 5mg ,2次 /d ,口服 3～5d。根治手术包括三套圈结扎和电凝 (超声刀 )。结果 腹腔镜手术无论何种方式越熟练时间越短 ,出血越少 ;其中运用超声刀行开窗取卵术尤佳 ;开窗取卵后加用米非司酮 ,持续性异位妊娠率为零。结论 异位妊娠希望保留生育功能者日渐增多 ,首选腹腔镜下输卵管开窗取卵术 ;减少切口出血 ,避免反复止血 ,是保守成功的关键 ;术后密切观察血中人绒毛膜促性腺激素 (chumanchorioinicgonadotrophin ,HCG)值 ,辅助用药可避免持续性异位妊娠。

Objective To explore the clinical significancy of various treatments of laparoscopy in ectopic pregnancy.Methods There were 238 cases applying laparo scopy during 1998 to 2002.Conservative operations included local medicine injection and oviduct fenestration or having.embryo taken from the nick.Effective radical operations included tubal ligation with three roeder loops and salpingectomy with ultrasonic knife.Results The more skilled operators took less time and had less bleeding during operation.Tubal salpingectomy with ultrasonic knife had the best result.After oviduct fenestration or having.embryo taken from the nick.,taking RU486 could have better result ,the rate of repeated ictopic pregnancy being zero in this series.Conclusion Pregnancy sufferers who require to reserve the fertility,laparoscopy should be the first choice.It is the key for conservative operations to reduce the probability of wound bleeding and avoid arresting bleeding repeatedly during operation.To avoid repeated ectopic pregnancy,HCG monitoring and taking auxilitary medicine after operation are important.