电刀辅助开腹下输卵管妊娠的保守性手术临床研究

Clinical study on conservative surgery with auxiliary electrotome for tubal ectopic pregnancy

目的探讨电刀辅助开腹下输卵管妊娠的保守性手术治疗的效果及安全性。方法对2005年8月至2007年8月在我院住院并要求行保守性手术的输卵管妊娠患者随机分为电刀辅助开腹组(A)30例和腹腔镜组(B)40例,比较两组手术时间、术中出血量、术后镇痛率、肛门排气时间、术后发热率、持续性异位妊娠率、输卵管再通率、输卵管瘘率、2年内再次异位妊娠率、2年内宫内孕率。结果手术时间A组为(73.60±28.30)m in、B组(71.30±27.60)m in;术中出血量A组为(50.30±14.66)mL、B组为(25.40±13.22)mL;肛门排气时间A组为(32.60±7.66)m in、B组为(20.30±5.33)m in;术后镇痛率A组为66.67%(20/30)、B组为22.50%(9/40);术后发热率A组为23.33%(7/30)、B组为7.50%(3/40);持续性异位妊娠率A组为0%、B组为5.00%(2/40);输卵管再通率A组为93.33%(28/30)、B组为92.50%(37/40);均无输卵管瘘发生;2年内再次异位妊娠率A组为6.67%(2/30)、B组为17.50%(7/40);2年内宫内孕率A组为83.33%(25/30)、B组为77.50%(31/40)。上述各指标中除了术中出血量及术后镇痛率电刀辅助开腹组明显高于腹腔镜组(P<0.05)外,其余方面差异均无统计学意义(P>0.05)。结论输卵管妊娠保守性手术治疗在电刀辅助开腹下与腹腔镜下同样有效安全,电刀辅助开腹下手术简单经济,适合无腹腔镜手术条件、经济困难的患者。

Objective To investigate the efficacy and safety of laparotomy surgery with auxiliary electrotome for tubal ectopic pregnancy. Methods From Aug. 2005 to Aug. 2007,70 cases of tubal ectopic pregnancy admitted to our hospital were divided into two groups：laprotomy group （group A：30 cases underwent laparotomy with auxiliary electrotome） and laparoscopic group （group B ：40 cases underwent laparoscopic surgery）. The operating time, the intraoperative blood loss, anal exhaust time, postoperative analgesic rate, heating rate, continuing ectopic pregnant rate, tubal repatent rate, reduplicate tubal ectopic pregnant rate in 2 years,intrauterine pregnant rate in 2 years in two groups were compared. Results The operating time was （73.60 ± 28.30） minutes in group A and （71.30 ± 27.60） minutes in group B, the intraoperative blood loss was （50.30 ± 14.6） ml in group A and （ 25.40 ± 13.22 ） ml in group B, anal exhaust time was （ 32.60 ± 7.66 ） hours in group A and （20. 30 ± 5.33 ） hours in group B, postoperative analgesic rate was 66.67 percent （ 20/30 ） in group A and 22.50 percent（9/40） in group B,heating rate was 23.33 percent（7/30） in group A and 7.50 percent（3/40） in group B, continuing ectopie pregnant rate was 0 percent in group A and 5.00 percent（2/40） in group B, and tubal repatent rate was 93.33 percent（28/30） in group A and 92.50 percent（37/40） in group B. There were no tubal fistulas in two groups,reduplicate tubal ectopic pregnant rate in 2 years was 6.67 percent（2/30） in group A and 17.50（7/40） percent in group B,intrauterine pregnant rate in 2 years was 83.33 percent（25/30） and 77.50 percent（31/40） in group B. Among all index mentioned above, only intraoperative blood loss and postoperative analgesic rate were significantly higher in group A than those in group B （ P 〈 0. 05 ）, no significant difference was found in the others between the two groups （ P 〉 0. 05 ）. Conclusion Laparotomic conservative surgery for tubal pregnancy with electrome is as safe and effective as laparoscopy. It is simple and economic, especially suitable to situation of having no laparoscopy and for patients with limited financial source.