腹腔镜治疗异位妊娠中转开放手术的原因分析

Analysis of reasons for conversion to laparotomy during laparoscopic procedure of ectopic pregnancy

目的探讨导致腹腔镜治疗异位妊娠中转开放手术的原因。方法回顾性地分析腹腔镜治疗的异位妊娠232例患者的临床资料,对相关的因素进行统计学分析。结果中转开放手术25例。腹腔镜经验较少的医师腹腔镜手术中转开放的概率显著增加,在中转开放组中,盆腔炎病史、术前B超示大量腹腔积液以及输卵管破裂的比例显著高于腹腔镜组(分别为24%和8.7%,24%和7.42%,68%和42.51%)。两组间肥胖和异位妊娠包块的大小等因素比较差异无统计学意义。结论术者腹腔镜经验少、既往盆腔炎病史、超声示腹腔大量积液、输卵管破裂使腹腔镜治疗异位妊娠中转开放的可能性显著增加。

Objective To identify the reasons for conversion to laparotomy during laparoscopic procedure of ectopic pregnancy. Methods We reviewed retrospectively the data of 232 patients who underwent laparoscopy for treatment of ectopic pregnancy and the relative factors for conversion to laparotomy were analyzed statistically. Results Out of the 232 laparoscopies, 25 converted to laparotomy. The rate of conversion was significantly higher for less experienced compared to experienced surgeon. Significantly more women had the history of pelvic inflammatory disease in the converted group compared to the non -converted group （24% vs. 8.7% ） and the converted group had significantly higher rate of large free fluid reported on ultrasound and ruptured fallopian tube compared to the non -converted group （ 24% vs. 7.24% and 68% vs. 42.51% respectively）. Conclusion Less experienced surgeon, history, of pelvic inflammatory, disease, large amount of free fluid on ultrasound and ruptured fallopian tube increase the risk of conversion to laparotomy during laparoscopic procedure of ectopic pregnancy.