腹腔镜和经腹手术治疗妊娠合并卵巢囊肿患者的临床比较

Clinical comparison of 59 cases of ovarian cysts treated with laparoscopy combined with trans-abdominal operation during pregnancy

目的通过比较腹腔镜和经腹手术治疗妊娠合并卵巢囊肿的临床数据,探讨妊娠合并卵巢囊肿行腹腔镜手术的可行性及疗效。方法回顾性分析2015年2月—2018年2月在安徽省立医院妇产科收治的59例妊娠合并卵巢囊肿的患者,其中早孕期9例,中孕期49例,晚孕期1例。根据患者自身意愿分组,选择腹腔镜手术或经腹手术,其中36例腹腔镜手术组与23例经腹手术组,因早孕期及晚孕期数据较少,无法进行统计学分析。故分析中孕期2组患者的各项临床资料,包括患者年龄、孕周、囊肿直径、手术时间、术中出血、术后通气时间、平均住院日、流产率。计量资料采用±s表示,使用t检验。结果所有患者均成功完成手术,所有患者均按期出院,无术后并发症发生。所有腹腔镜手术组的36例无中转开腹。中孕期腹腔镜手术组的患者年龄(26.2±3.4)岁,孕周(16.8±2.6)周,囊肿直径(7.9±2.5)cm,手术时间为(62.08±20.70)min,术中出血(20.24±13.42)ml,术后通气时间(21.78±8.45)h,平均住院日为(6.48±1.77)d。中孕期经腹手术组的患者年龄(26.1±4.1)岁,孕周(17.2±3.2)周,囊肿直径(8.2±3.1)cm,手术时间为(94.61±16.62)min,术中出血(27.16±23.53)ml,术后通气时间(40.79±10.53)h,平均住院日(8.55±1.97)d。2组在年龄、孕周及囊肿直径比较差异无统计学意义(均P>0.05),在手术时间、术后通气时间及平均住院日比较差异有统计学意义(均P<0.05)。结论妊娠合并卵巢囊肿行腹腔镜手术具有术后恢复快,住院时间短等特点,是可行的和安全的,可以临床应用。因妊娠的特殊时期,需加强麻醉中的监护以及加强术后护理并行保胎治疗。

Objective To investigate the feasibility and efficacy of laparoscopy in pregnancy with ovarian cysts by com- parison of the clinical data obtained from laparoscopic and transabdominal surgery. Methods A retrospective analysis was made of 59 cases of ovarian cysts in pregnancy was treated in gynecology and obstetrics department of Anhui Provin- cial Hospital from February, 2015 to February, 2018, including 36 cases of laparoscopic surgery group and 23 cases of open surgery group with 9 cases of early pregnancy, 49 cases of mid pregnancy and 1 case of late pregnancy. Insufficient data in early pregnancy and late pregnancy made statistical analysis impossible to be carried out. Thus, clinical data was analyzed in the cases of middle pregnancy, including age, gestational weeks, cyst diameters, operation time, bleeding in operation, postoperative ventilation time, and average length of stay and abortion rate. The measurement data were ex- pressed by x ＋ s, and t test was used. Results All 59 patients successfully completed the operation, and all patients were discharged on schedule, without postoperative complications. And 36 cases of laparoscopic surgery were without conversion to open surgery. In the middle pregnancy group, the age of patients in laparoscopic surgery group was （26.2± 3.4） years of age, gestational age （16.8 ± 2.6） weeks, and cyst diameter （7.9 ±2.5 ） cm. The operative time of laparoscopic surgery group was （62.08± 20.70） min, intraoperative bleeding （20.24± 13.42） ml, postoperative ventilation time （21.78 ± 8.45） h, and the average hospitalization stay was （6.48 ± 1.77） days. The age of patients in abdominal operation group was （26.1 ± 4.1 ） years of age, gestational age （ 17.2± 3.2） weeks, and cyst diameter （8.2 ± 3.1 ） cm. The operative time of abdominal operation group was （94.61 ± 16.62） min, intraoperative bleeding （ 27.16 ± 23.53 ） ml, postoperative ventilation time （40.79 ± 10.53 ） h, and average hospitalization stay （ 8.55± 1.97 ） days. There was no significant difference in age, gestational age and cyst diameter between the two groups （P 〉 0.05）. There was a significant difference between the two groups in the operation time, the postoperative ventilation time and the average hospitalization days （P 〈 0.05 ）. Conclusion Laparoscopic surgery in pregnancy with ovarian cysts has the characteristics of quick recovery and short hospitalization. It is feasible and can be used clinically. It is necessary to strengthen the monitoring of anesthesia. And it is essential to strengthen the postoperative nursing and tocolytic therapy.