腹腔镜与开腹手术治疗妊娠合并卵巢囊肿的比较

Comparison Between Laparoscopic and Open Surgery for Ovarian Cysts During Pregnancy

目的探讨腹腔镜手术治疗妊娠合并卵巢囊肿的安全性及疗效。方法 2010年1月～2015年1月收治27例妊娠合并卵巢囊肿,行腹腔镜手术15例（腹腔镜组）,开腹手术12例（开腹组）,回顾性分析患者手术及妊娠结局。结果27例手术均顺利完成,腹腔镜组无中转开腹。与开腹组相比,腹腔镜组手术时间短[（49.2±8.4）min vs.（71.4±12.3）min,t=-5.551,P=0.000],术中出血少[（14.9±11.3）ml vs.（44.2±22.7）ml,t=-4.378,P=0.000],术后下床活动早[（19.3±5.0）h vs.（34.2±11.1）h,t=-4.670,P=0.000],术后排气早[（13.1±5.6）h vs.（21.7±5.4）h,t=-4.007,P=0.000],住院时间短[（6.7±1.3）d vs.（9.2±1.5）d,t=-4.519,P=0.000]。腹腔镜组13例成功分娩足月健康婴儿,新生儿无窒息、畸形,2例继续妊娠。开腹组1例完全流产,10例成功分娩足月健康婴儿,新生儿无窒息、畸形,1例继续妊娠。2组流产率差异无显著性[0%（0/15）vs.8.3%（1/12）,Fisher检验,P=0.444]。结论腹腔镜手术治疗妊娠合并卵巢良性囊肿,创伤小,术后恢复快,安全可行。

Objective To investigate the curative effect and safety of laparoscopic surgery for ovarian cysts during pregnancy.Methods A total of 27 pregnant women with ovarian cysts underwent surgery between January 2010 and January 2015,including 15 cases of laparoscopic surgery and 12 cases of laparotomy. Clinical data were analyzed retrospectively. Results Laparoscopic surgery and laparotomy were successfully performed in all the patients. As compared to the laparotomy group,the laparoscopic group had shorter operation time [（ 49. 2 ± 8. 4） min vs.（ 71. 4 ± 12. 3） min,t =- 5. 551,P = 0. 000],less blood loss [（ 14. 9 ± 11. 3） ml vs.（ 44. 2 ± 22. 7） ml,t =- 4. 378,P = 0. 000],earlier postoperative out-of-bed activities [（ 19. 3 ± 5. 0） h vs.（ 34. 2 ± 11. 1） h,t =- 4. 670,P = 0. 000],shorter postoperative exhaust time [（ 13. 1 ± 5. 6） h vs.（ 21. 7 ± 5. 4） h,t =- 4. 007,P = 0. 000],and shorter hospital stay [（ 6. 7 ± 1. 3） d vs.（ 9. 2 ± 1. 5） d,t =- 4. 519,P = 0. 000]. In the laparoscopic group,13 patients were pregnant to term delivery after operation and 2 patients continued on their pregnancy. In the laparotomy group,inevitable abortion happened in 1 case,10 cases were pregnant to term delivery after operation,and 1 patient continued on her pregnancy. The newborns were all normal in the two groups. As compared to the open group,no statistical significance was found in total abortion rate in the laparoscopic group [0%（ 0 /15） vs. 8. 3%（ 1 /12）,Fisher ＇s exact test,P = 0. 444]. Conclusion In comparison with laparotomy,laparoscopic surgery for ovarian cysts during pregnancy is a technique with less trauma and quick recovery and has no harmful influence on pregnancy.