无气腹腹腔镜手术治疗妊娠合并卵巢良性肿瘤10例临床分析

Clinical study of gasless laparoscopy in the treatment of benign ovarian tumor in 10 pregnant women

目的 探讨妊娠期无气腹腹腔镜手术的可行性、安全性以及治疗效果.方法 回顾性分析2006年8月至2010年8月北京安贞医院妇产科收治的妊娠15～ 24周、卵巢良性肿瘤直径＞5 cm、采取元气腹腹腔镜手术的10例患者的临床资料.观察手术时间、术中出血量、住院时间；胎儿及新生儿情况及术中、术后并发症发生情况.结果 完成卵巢良性肿瘤剔除手术10例,其中成熟畸胎瘤4例、上皮性肿瘤5例、卵巢内异症囊肿1例.平均手术时间（30±5） min；平均术中出血（30±8） ml,平均术后住院时间（6±2）d.患者术前、术中、术后血气分析（pH值分别为：7.42±0.11、7.41±0.18、7.42 ±0.12）、血压[平均动脉压分别为（90.4±3.1）、（90.6±0.7）、（89.7±0.8）mm Hg（1 mm Hg =0.133 kPa）]及心率[（84.0±1.6）、（84.3±1.7）、（82.7±1.1）次]监测结果分别比较,差异均无统计学意义（P均＞0.05）.术前、术中、术后监测胎心均在正常范围内.10例患者术中、术后均无并发症发生,且均已妊娠至足月分娩,新生儿出生体质量和Apgar评分未发现异常.结论妊娠期无气腹腹腔镜手术对母胎安全、可行.

Objective To investigate the feasibility,safety and effect of gasless laparoscopic surgery used in patients at the second trimester.Methods From Aug.2006 to Aug.2008,the data of 10 cases at gestational 15 - 24 weeks complicated by ovary benign tumors （ the diameters more than 5 cm） undergoing gasless laparoscopic surgery were studied retrospectively.Operation time,bleeding loss,period of hospitalization,the status of fetus and newborn babies,and peri-operative or postoperative complications were observed.Results All 10 cases were treated by gasless laparoscopic surgery,including 4 cases with mature teratoma,5 cases with epithelial tumors and 1 case with ovarian endometrioma.The mean time of surgery was （30 ± 5） minutes,the mean bleeding in the surgery was （30 ± 8） ml,the mean period of in hospitalization was （ 6 ± 2 ） days.The blood gas （ pH：7.42 ± 0.11,7.41 ± 0.18,7.42 ± 0.12 ）,blood pressure [ mean arterial pressure （MAP）：（90.4 ± 3.1 ）,（90.6 ± 0.7 ）,（ 89.7 ± 0.8） mm Hg（ 1 mm Hg =0.133 kPa） ] and heart rates [ （ 84.0 ± 1.6）,（ 84.3 ± 1.7 ）,（ 82.7 ± 1.1 ） bpm ] in all cases at pre,peri and postoperative time did not show statistical difference （ P all 〉 0.05 ）.The fetal hearts were all in the normal range preoperative,intraoperative and postoperative time （P 〉 0.05 ）.No perioperative and postoperative complications were observed.All the cases underwent term delivery.Fetal weight and Apgar score did not show abnormality.Conclusion Gasless laparoscopic surgery at the second trimester is feasible and safe to mother and fetus.