基层医院腹腔镜手术治疗异位妊娠出血性休克的可行性研究

Research on feasibility of laparoscopic surgery in treatment of ectopic pregnancy hemorrhagic shock in primary hospital

目的评价腹腔镜手术治疗异位妊娠出血性休克孕妇的可行性,探讨其在基层医院临床适用性。方法回顾性分析2013年5月~2015年7月于我院就诊采用腹腔镜手术治疗的异位妊娠出血性休克孕妇,作为试验组,另选择同时期的采用开腹手术治疗的异位妊娠出血性休克孕妇,作为对照组,每组各30例。观察并详细记录患者术中一般情况和抢救成功率、术后一般情况及术后感染情况。结果两组患者的平均舒张压、平均收缩压、平均心率、总输血量和抢救成功率差异均无统计学意义(P>0.05),试验组患者的术中出血量和手术时间均明显低于对照组患者(P<0.05);试验组患者住院天数、术后肠胃功能恢复时间和术后下床活动时间均明显低于对照组患者(P<0.05);试验组患者感染率为3.33%(1/30),对照组患者感染率为10.00%(3/30),差异无统计学意义(x^2=1.07,P=0.30)。结论腹腔镜手术在治疗异位妊娠出血性休克孕妇可以达到和开腹手术同样的效果,且创伤性较小,对术中和术后的影响较小,术后感染发生率较低,在基层医院的手术技术相对成熟适用。

Objective To evaluate the feasibility of laparoscopic surgery in treatment of pregnant women with ectopic pregnancy hemorrhagic shock to explore its clinical applicability in primary hospital. Methods Pregnant women with ectopic pregnancy hemorrhagic shock who were received laparoscopic surgery in our hospital from May 2013 to July 2015 were retrospectively analyzed and they were set as the experimental group. Pregnant women with ectopic pregnancy hemorrhagic shock who were received open surgery in our hospital during the same period were set as the control group. Each group had 30 cases. General condition and successful rescue rate during the operation, postoperative general condition and postoperative infection of patients were observed and detailedly recorded. Results Average diastolic pressure, average systolic pressure, average heart rate, total blood transfusion volume and the success rescue rate of patients in two groups of patients had no significant difference（P〈 0.05）. Intraoperative blood loss and operation time of patients in the experimental group were significantly less than those in the control group（P〈 0.05）. The hospital stay, postoperative gastrointestinal function recovery time and postoperative out of bed activity time of the experimental group were significantly less than those in the control group（P〈 0.05）. Infection rates of patients in the experimental group and the experimental group were 3.33%（1/30） and 10.00%（3/30） respectively. The difference was not statistically significant（x^2=1.07, P=0.30）. Conclusion Laparoscopic surgery in the treatment of pregnant women with ectopic pregnancy hemorrhagic shock can achieve the same effect as the open surgery. In addition, it is less invasive and it has fewer effects on the intraoperative and postoperative conditions and lower incidence of postoperative infection. Surgical technique was relatively maturely applicable in the primary hospital.