生命体征稳定输卵管妊娠流产手术时机探讨

Discussion on the timing of vital signs to stabilize the abortion of tubal pregnancy

目的:探讨生命体征稳定输卵管妊娠流产手术时机对保护患侧输卵管功能的重要性。方法:选择2014年6月至2018年6月生命体征稳定输卵管妊娠流产并有生育要求患者,确诊后予以MTX及米非司酮联合杀胚治疗,复查血清β-HCG,血清β-HCG下降时行腹腔镜下输卵管挤压术治疗的30例为观察组;选择同期确诊后即要求行腹腔镜下输卵管开窗取胚术的32例患者为对照组,术中予垂体后叶素6U+0.9%的氯化钠溶液5mL行患侧宫角及包块远端输卵管系膜内注射。比较两组在手术时间、术中出血量、术后最高体温、手术并发症及术后患侧输卵管的通畅程度。结果:观察组手术时间、术中出血量少于对照组(P<0.05);观察组持续性异位妊娠发生率低于对照组(P<0.01);观察组术后输卵管通畅率高于对照组(P<0.01);两组术后最高体温无明显差异(P>0.05)。结论:生命体征稳定输卵管妊娠流产保留输卵管功能选择手术时机时,术前药物杀胚治疗,监测患者生命体征及B超了解盆腔积液情况,选择血清β-HCG下降时为手术时机,能更好地保护患侧输卵管功能。

Objective:To investigate the importance of vital signs for stable tubal pregnancy abortion surgery to protect the function of the affected fallopian tube. Methods: Patients with stable vitals due to abortion of tubal pregnancy from June 2014 to June 2018 were enrolled. Patients with fertility requirements were treated with MTX and mifepristone in combination with embryo therapy. The serum β-HCG was reviewed and serum β-HCG decreased. Thirty patients undergoing laparoscopic tubal squeezing were included in the observation group. 32 cases of laparoscopic fallopian tube fenestration were selected as the control group after the diagnosis. The intraoperative pituitary vasopressin 6U+ saline 5mL line The affected side of the uterine horn and the distal end of the mass of the tubal were injected intramembranously. The operation time, intraoperative blood loss, maximum postoperative temperature, surgical complications and patency of the fallopian tube were compared between the two groups.Results:The operation time and intraoperative blood loss were lower in the observation group than in the control group ( P < 0.05). The incidence of persistent ectopic pregnancy in the observation group was lower than that in the control group ( P < 0.01). The patency rate of the fallopian tube in the observation group was higher than that in the control group ( P < 0.01). There was no significant difference in the highest body temperature between the two groups ( P > 0.05). Conclusion:Vital signs stable tubal pregnancy abortion retention of tubal function selection surgery timing, preoperative drug embryo treatment, monitoring patient vital signs and B-ultrasound to understand pelvic fluid, select serum β-HCG decline when surgery time, can better protect the affected side of the fallopian tube function.