腹腔镜手术与剖腹手术治疗出血性休克型宫外孕的效果比较

Clinical Effect of Shocked Ectopic Pregnancys with Intra-Abdominal Bleeding Treatment by Laparoscopic Operation and Laparotomy

目的比较腹腔镜手术与剖腹手术治疗出血性休克型宫外孕的效果。方法将100例出血性休克型宫外孕患者随机分为2组:腹腔镜组和剖腹组,每组50例。腹腔镜组行腹腔镜手术治疗,剖腹组行常规剖腹手术治疗。比较2组手术及住院情况。结果腹腔镜组的输卵管妊娠破裂发生率、腹腔内出血量、输卵管切除率、输卵管切开率与剖腹组比较差异均无统计学意义(P均>0.05);腹腔镜组的手术时间、术中出血量、术后疼痛发生率、术后发热发生率、术后应用抗生素时间、术后肛门排气时间及住院时间与剖腹组比较差异均有统计学意义(P均<0.05)。结论出血性休克型宫外孕在一定条件下进行腹腔镜手术是安全、有效的,但血压低于60/30 mm Hg、腹腔内出血量>2 000 mL或血源不足、合并严重盆腔粘连者则暂不主张行腹腔镜手术。

Objective To compare the clinical effect of laparoscopic operation and laparotomy in treating shocked ectopic pregnancy with intra-abdominal bleeding. Methods One hundred patients with shocked ectopic pregnancy with intra-abdominal bleeding were randomly divided into two groups： laparoscopic group（50 cases） and laparotomy group（50 cases）. The results and complexion were compared between the two groups. Results The rate of rupture in tubal pregnancy and the amount of intra-abdominal bleeding, the rate of removaling or sundering fallopian tube in laparoscopic group showed no difference from those of laparotomy group（all P〉0.05）. The time of operation, the amounts of bleeding, the rate of pain and fever, the time of using antibiotics, the period of pass gas and the time of hospitalization in laparoscopic group were all significantly less than those of laparotomy group（all P〈0. 05）. Conclusion Laparoscopic operation is safe and effective in the condition for the treatment of shocked ectopic pregnancy with intra-abdominal bleeding, but it is forbidden if blood pressure〈60/30 mm Hg, the amount of intra-abdominal bleeding〉2 000 mL, the scarcity of providing blood, serious conglutination in basin antrum.