腹腔镜下输卵管切开术中垂体后叶素不同使用方法的比较

Comparative Study of Two Different Methods of Hypophysin Use During Laparoscopic Salpingotomy for Tube Pregnancy

【目的】探讨垂体后叶素两点注射法在腹腔镜下输卵管妊娠切开术中的应用价值。【方法】将2006年6月-2007年12月我院妇科未破裂输卵管妊娠患者200例,均行腹腔镜下输卵管切开术,分成3组,其中术中两点注射垂体后叶素组(观察1组)72例、单点注射垂体后叶素组(观察2组)62例和未使用垂体后叶素组(对照组)66例。比较3组的手术时间、术中出血量、术后最高体温、手术并发症等。【结果】观察1组和观察2组的手术时间、术中出血量均明显少于对照组(P<0.05),观察1组少于观察2组(P<0.05)。观察1组的持续性宫外孕发生率低于对照组(P<0.01),观察2组的持续性宫外孕发生率与观察1组和对照组比较无显著性差异(P>0.05)。3组术后最高体温无明显差异(P>0.05)。使用垂体后叶素的患者无1例不良反应发生。【结论】在腹腔镜下输卵管切开术中应用垂体后叶素注射,能减少术中出血,缩短手术时间并减少持续性宫外孕等并发症的发生,在患侧宫角及输卵管系膜两点注射法优于输卵管系膜单点注射法,两种方法都安全可靠。

[Objective] To evaluate the feasibility of hypophysin injection into both comua uteri and mesosalpinx （two point injection） during laparoscopic salpingotomy for tube pregnancy. [Methods] From June 2006 to December 2007, 200 cases of unruptured tube pregnancy udergoing laparoscopic salpingotomy were divided into three groups. In the study group 1, 72 patients received prophylactic dilute hypophysin injection into both comua uteri and mesosalpinx. In the study group 2, 62 patients received prophylactic dilute hypophysin injection into mesosalpinx （study group 2）, and 66 patients did not receive vasopressin in the control group. The duration of operation, intraoperative blood loss, complications of persistent ectopic pregnancy and postoperative highest temperature were recorded. [Results] The duration of operation and the intraoperative blood loss in two study groups were significantly less than those in the control group （P 〈 0.05）. The duration of operation and the intraoperative blood loss in study group 1 was less than those in the study group 2 （P 〈 0.05）, and the incidence of persistent eetopic pregnancy was significantly lower in the study group 1 than that in the control group （P 〈 0.01 ）. There were no significant difference in the postoperative highest temperature among three groups （P 〉 0.05）. The rate of unobstruction of oviduct and pregnancy after operation in the study group 2 were higher than those of control group （P 〈 0.05）. No side effect happened with hypophysin use in this study. [Conclusions] The duration of operation,interoperative bleeding and the rate of persistent ectopic pregnancy can be reduced by the use of hypophysin during laparoscopic salpingotomy. The method of hypophysin injection into both cornua uteri and mesosalpinx is superior to another method. Two methods are safe and feasible during laparoscopic salpingotomy for tube pregnancy.