系膜内注射垂体后叶素在腹腔镜输卵管妊娠保守手术中的应用

Application of posterior pituitary hormone mesentery injection in the laparoscopic conservative surgery for tubal pregnancy

目的:对比腹腔镜保守性手术与系膜内注射垂体后叶素联合腹腔镜保守手术治疗输卵管妊娠的临床效果。方法:回顾分析246例异位妊娠患者行腹腔镜保守手术的临床资料,根据手术方式分为两组,160例直接行腹腔镜保守性手术(对照组),86例于系膜内注射垂体后叶素后行腹腔镜保守手术(实验组)。对比分析两组患者手术时间、输卵管切口出血量、术后β-hCG下降至正常时间、术后持续输卵管妊娠的发生率。结果:实验组手术时间、输卵管切口出血量明显优于对照组,两组相比差异有统计学意义(P<0.01),其中实验组40例(46.5%)输卵管切开后无需双极电凝止血,对照组32例(20%)因双极电凝无法止血改为缝扎止血。两组患者术后β-hCG降至正常时间、持续性输卵管妊娠率差异无统计学意义(P>0.05)。结论:系膜内注射垂体后叶素联合腹腔镜保守手术可显著缩短手术时间、减少输卵管切口出血量,部分可达到无血切口,且不影响术后β-hCG,不增加持续性输卵管妊娠发生率,疗效确切。

Objective：This paper aims to compare the effects of direct laparoscopic conservative surgery with laparoscopic con- servative surgery after posterior pituitary hormone mesentery injection for tubal pregnancy. Methods ： The clinical data of 246 cases of laparoscopic conservative surgery for patients with ectopic pregnancy were retrospectively analyzed. According to the different surgical methods,they were divided into 2 groups, 160 cases underwent laparoscopic conservative surgery as the control group;86 cases under- went laparoscopic conservative surgery after posterior pituitary hormone mesentery injection as experimental group. The operation time, blood loss of fallopian tube, time of β-hCG decreasing to normal level, persistent ectopic pregnancy rate in two groups were compared. Results：The operation time of experimental group was shorter than that in the control group with significant difference （P 〈 0.01 ） ;The blood loss of experimental group was less than that in the control group with significant difference （P 〈0.01 ）. 40 cases （46.5%） in experimental group did not need bipolar coagulation for hemostasia during section of the fallopian tubes;and 32 cases （20%） in the control group were converted to suture from bipolar coagulation because of difficult hemostasia. There were not significant differences be- tween two groups in postoperative recovery time of β-hCG to normal level and persistent postoperative tubal pregnancy rate （ P 〉 0.05 ）. Conclusions ：The posterior pituitary hormone mesentery injection combined with laparoscopic conservative surgery can significantly shorten the operative time,reduce the fallopian tube incision blood loss （no blood loss is found in some incisions） ,and does not affect β-hCG and the incidence of persistent postoperative tubal pregnancy with exactly curative effect.