血流阻断法在腹腔镜下输卵管间质部妊娠切开取胚术中的应用

Application of blocking blood flow in laparoscopic opening-taking embryo operation on interstitial tubal pregnancy

目的 探讨血流阻断法在腹腔镜下输卵管间质部妊娠切开取胚术中的安全性和可行性.方法 选择2006年1月至2013年12月本院术前诊断输卵管间质部妊娠要求保留生育功能的患者98例为研究对象,并按手术时期分为研究组56例（2010年1月至2013年12月）和对照组42例（2006年1月至2009年12月）,两组患者均行腹腔镜下输卵管间质部妊娠切开取胚术,研究组术中暂时阻断患侧子宫动脉和卵巢动脉对妊娠部位的血流供应,再切开妊娠包块,予水压分离法剥离妊娠囊;对照组术中不阻断患侧子宫动脉和卵巢动脉对妊娠部位的血流供应.比较两组手术成功率、术中出血量、手术时间、术后持续性异位妊娠（PEP）发生率及术后输卵管通畅情况.结果 研究组手术成功率（96.4％）明显高于对照组（61.9％）（P＜0.01）,术中出血量[（20.7±10.4）ml]显著少于对照组[（60.7±18.4）ml]（P ＜0.01）,手术时间[（46.6±14.2） min]显著短于对照组[（66.5±19.4）min]（P＜0.01）,研究组无持续性异位妊娠发生,对照组发生5例（11.9％）,研究组术后输卵管通畅率（76.9％）高于对照组（41.7％）（P＜0.05）.结论 血流阻断法在腹腔镜下输卵管间质部妊娠切开取胚术中是安全、有效的,可用于输卵管间质部妊娠切开取胚术.

Objective To explore the safety and feasibility of blocking blood flow in interstitial tubal pregnancy treated with laparoscopic opening-taking embryo operation.Methods The clinical data of 98 patients with lump interstitial tubal pregnancies （requesting reserve procreate function） from January 2006 to December 2013 were chosen.Among them,56 patients were in study group （January 2010-December 2013） and 42 patients were in control group （January 2006-December 2009）.All patients were treated with opening-taking embryo by laparoscopic operation.In study group,we first blocked the uterine artery and ovarian artery blood supply of pregnancy lump,secondly opened pregnancy lump and stripped gestation sac with hydraulic pressure separation during operation.Whereas,in control group,we opened pregnancy lump and taken out pregnancy tissues according to convention method without blocking blood flow.Operation success rate,operation blood volume,operation time,persistent ectopic pregnancy （PEP） happening rate,fallopian tube unobstructed information,and pregnancy information after operation were compared between two groups.Results In study group,operation success rate was 96.4%,which was significantly higher than that in control group （61.9%） （P 〈0.01） ; operation blood volume was[（20.7 ± 10.4）ml],which was significantly less than that in control group [（60.7 ± 18.4） ml] （P 〈 0.01） ; operation time [（46.6 ±14.2） min] was significantly shorter than that in control group [（66.5 ± 19.4） min] （P 〈 0.01） ; there was no PEP in study group,while there were 5 PEPs （11.9%） in control group.Fallopian tube unobstructed rate after operation in study group （76.9%） was significantly higher than that in control group （41.7%） （P 〈 0.05）.Conclusions Application of blocking blood flow in opening-taking embryo by laparoscopic operation on lump interstitial tubal pregnancies is safe and effective.