无气腹腹腔镜治疗妊娠合并卵巢囊肿的临床研究

Clinical study of gasless laparoscopy on the treatment of pregnancy with ovarian cyst

目的探讨无气腹腹腔镜(GLS)治疗妊娠合并卵巢囊肿的临床疗效和安全性、经济性。方法重庆市第五人民医院2011年5月至2014年5月施行无气腹(A组)和气腹腹腔镜(B组)手术治疗妊娠合并卵巢囊肿60例患者。观察2组患者的平均动脉压、心率、血氧饱和度、血气分析、手术时间、术中出血量、术后肛门排气时间、拔尿管时间、住院时间、住院费用,以及术后并发症发生情况,宫缩、阴道流血、先兆流产及分娩、新生儿Apgar评分。结果平均动脉压、心率、血氧饱和度及血气结果显示,A组术前和术后比较差异无统计学意义(P>0.05);B组术前和术后比较差异有统计学意义(P<0.05);术后2组间比较差异有统计学意义(P<0.05)。A组手术时间、术中出血量、术后肛门排气时间、住院时间、住院费用均小于B组(P<0.05);拔除尿管时间2组比较差异无统计学意义(P>0.05)。A组术后并发症发生率均小于B组(P<0.05)。A组宫缩、阴道流血、先兆流产发生率小于B组(P<0.05);2组足月分娩、新生儿Apgar评分大于7分发生率比较,差异无统计学意义(P>0.05)。结论 GLS是治疗妊娠合并卵巢囊肿的一种安全、经济并且疗效确切的方法。

Objective To investigate the effect,safety and economy of gasless laparoscopic surgery on the treatment of pregnancy with ovarian cyst.Methods From May 2011 to May 2014,the data of 60 cases at gestational 14-20 weeks complicated by ovarian cyst undergoing gasless laparoscopic surgery（group A）and laparoscopic surgery（group B）were studied retrospectively.Mean arterial pressure,heart rate,oxygen saturation,blood gas,operation time,intraoperative bleeding volume,postoperative anal exhaust time,catheter removal time,hospitalization time and cost,peri-operative or postoperative complications,uterine contraction,vaginal bleeding,threatened abortion,term delivery,neonatal Apgar score were observed.Results Mean arterial pressure,heart rate and saturation of blood oxygen and blood gas results show：group A of preoperative and postoperative indexes had no significant statistical difference（P〉0.05）,group B of preoperative and postoperative indicators had significant difference（P〈0.05）,postoperative indicators had significant difference（P〈0.05）between group A and B.Group A were significantly less than group B about Operation time,blood loss,postoperative anal exhaust time,hospitalization time and cost（P〈0.05）,two groups were not significantly different in catheter removal time（P〉0.05）.Complications incidence in group A were significantly less than group B（P〈0.05）.Occurrence rate of uterine contraction,vaginal bleeding,threatened abortion in group A were significantly less than group B（P〈0.05）,the rate of term delivery and neonatal Apgar score（≥7）had no statistical significance（P〉0.05）.Conclusion Gasless laparoscopic surgery is a safe,economic and effective treatment of pregnancy（at the second trimester）associated with ovarian cyst.