垂体后叶素在输卵管妊娠腹腔镜保守手术中的应用价值

Effect of Pituitrin in Laparoscopic Conservative Surgery for Tubal Pregnancy

目的探讨垂体后叶素在输卵管妊娠腹腔镜保守手术中减少出血的价值。方法 2010年1～10月60例腹腔镜输卵管妊娠保守手术,采用前瞻、单盲对照的研究设计,单盲对象为受试者,按就诊时单、双号日分为2组:垂体后叶素组30例采用切开输卵管壁前患侧输卵管系膜注射垂体后叶素6 U加生理盐水共5 ml;生理盐水组30例采用切开输卵管壁前患侧输卵管系膜注射生理盐水5 ml。结果垂体后叶素组术中出血量中位数26.0 ml,显著少于生理盐水组中位数45.0 ml(Z=-2.234,P=0.025);垂体后叶素组手术时间(38.0±6.2)min,显著少于生理盐水组(46.0±8.9)min(t=-4.040,P=0.000);2组电凝止血输卵管分别15、25条,有统计学差异(χ2=7.500,P=0.006)。2组术后血β-hCG恢复正常的时间无显著性差异(P>0.05)。术后子宫输卵管造影:垂体后叶素组26例中23例患侧输卵管通畅,患侧输卵管通畅率88.5%(23/26);生理盐水组25例中19例患侧输卵管通畅,患侧输卵管通畅率76.0%(19/25),2组无统计学差异(χ2=0.639,P=0.423)。结论术中应用垂体后叶素能明显减少腹腔镜输卵管妊娠保守手术的出血,缩短手术时间。

Objective To investigate the value of pituitrin in reducing bleeding during laparoscopic tubal pregnancy conservative surgery. Methods From January 2010 to October 2010, 60 patients who were undergoing laparoscopic tubal pregnancy conservative surgery, were enrolled into this prospective, randomized, single-blind, controlled study. The patients were divided into two groups according to the date of admission, with 30 patients in each. Pituitrin group received pituitrin injection （6 U ＋ NS 5 ml） before cutting the fallopian tube membrane, while physiological saline group were injected with NS only （5 ml）. Result The median intraoperative blood loss in the pituitrin group was 26.0 ml and the mean operation time was （38.0 ± 6.2） rain, which were significantly less than those in the NS group [45.0 ml, Z = - 2. 234, P =0.025 ; （46.0± 8.9）min, t = -4. 040, P =0. 000]. The number of coagulated tube were 15 and 25, respectively in the two groups （X2 = 7. 500, P = 0. 006）. No significant difference was detected in the recovery time of serum β-hCG between the two groups （ P 〉 0.05 ）. Postoperative angiography showed the diseased tube was patent in 23 cases of the pituitrin group （88.5% , 23/26） and 19 cases of the NS group （76.0% , 19/25）, no significant difference was found in the rate of patency between the two groups （X2 = 0. 639, P = 0. 423）. Conclusion Intraoperative application of pituitary vasopressin significantly reduces operation time and blood loss during laparoscopic conservative surgery for tubal pregnancy.