腹腔镜手术治疗妊娠期卵巢良性肿瘤的疗效及对孕妇术后妊娠结局及子代短期预后的影响

Curative Effect of Laparoscopic Surgery on Gestational Benign Ovarian Tumors and Its Influences on Postoperative Pregnancy Outcome of Pregnant Women and Short-term Prognosis of Offsprings

目的探讨腔镜手术治疗妊娠期卵巢良性肿瘤的疗效及对孕妇术后妊娠结局及子代短期预后的影响。方法回顾性分析确诊为妊娠期卵巢良性肿瘤孕妇的临床诊治资料,根据手术方式不同分为腹腔镜组(50例,开展腹腔镜手术)与开腹组(40例,开展常规外科开腹手术)。统计2组孕妇手术完成情况与术后妊娠结局,通过新生儿Apgar评分和出生后2个月盖泽尔量表评估子代短期预后情况。结果2组孕妇手术均顺利完成,腹腔镜组未出现中转开腹病例,术后胎儿均存活。与开腹组相比,腹腔镜组孕妇手术时间、术后早期下床活动时间、肛门自动排气时间、住院时间明显缩短,硫酸镁用量、术中出血量明显少,且盆腔脏器损伤、术后胎心率异常发生率明显降低(P<0.05)。腹腔镜组流产率、早产率、剖宫产率及胎儿窘迫发生率明显低于开腹组(P<0.05),分娩后新生儿1 min、10 min Apgar评分明显高于开腹组(P<0.05),2个月时婴幼儿大动作、精细动作、认知能力、语言、社交行为方面评分较开腹组略高,但差异不显著(P>0.05)。结论腹腔镜手术治疗妊娠期卵巢良性肿瘤的疗效突出,有利于促进术后恢复,改善术后妊娠结局、新生儿娩出情况,且不影响子代短期预后。

Objective To explore the curative effect of laparoscopic surgery on gestational benign ovarian tumors and its influences on postoperative pregnancy outcome of pregnant women and short-term prognosis of offsprings.Methods The clinical diagnosis and treatment data of pregnant women confirmed with benign ovarian tumor were retrospectively analyzed.According to different surgical methods,they were divided into laparoscopic group(50 cases,laparoscopic surgery)and laparotomy group(40 cases,routine surgical laparotomy).The operation completion and postoperative pregnancy outcomes in both groups were statistically analyzed.The short-term prognosis of offsprings was assessed by neonatal Apgar score and Geiger scale at 2 months after birth.Results The operations of both groups were successfully completed.There was no case with conversion to laparotomy in laparoscopic group,all the fetus survived after surgery.Compared with laparotomy group,operation time,time of getting out of bed early after surgery,time of automatic anal exhaust and length of hospital stay were significantly shorter in laparoscopic group,dosage of magnesium sulfate and intraoperative blood loss were significantly less,incidence of pelvic organ damage,abnormal fetal heart rate was significantly lower(P<0.05).The incidence rates of abortion,preterm,cesarean section and fetal distress in laparoscopic group were significantly lower than those of laparotomy group(P<0.05),wihle Apgar scores of the newborns at 1 min and 10 min after delivery were significantly higher than those of laparotomy group(P<0.05).At 2 months,scores of big movements,fine movements,cognitive ability,language and social behavior were slightly higher than those of laparotomy group(P>0.05).Conclusion The curative effect of laparoscopic surgery is significant on gestational benign ovarian tumors.It can promote postoperative recovery,improve postoperative pregnancy outcomes and neonatal delivery,without affecting short-term prognosis of offsprings.