腹腔镜下单纯应用垂体后叶素与联合压脉带阻断子宫血流在宫角楔形切除术中的疗效比较

目的比较腹腔镜下单纯应用垂体后叶素与联合压脉带阻断子宫血流在宫角楔形切除术中的疗效。方法方便选取2022年8月—2023年7月在东莞市清溪医院住院并行腹腔镜宫角楔形切除手术的20例患者,根据患者接受手术方式的不同而分组。对照组手术止血方式是病灶基底部注射垂体后叶素止血,入选10例;联合组手术止血方式是病灶基底部注射垂体后叶素联合压脉带阻断子宫血流,同样入选10例。观察两组围术期指标与手术安全性(中转开腹率、有无手术并发症等)。结果联合组手术耗时(60.53±4.63)min更短,术中出血量(51.31±6.73)mL与治疗费用(12537.83±264.47)元更少,住院耗时(4.75±0.76)d短于对照组,差异有统计学意义(t=2.360、30.596、9.603、2.828,P<0.05)。联合组患者中转开腹率及手术并发症率均低于对照组,但两组比较,差异无统计学意义(P>0.05)。结论在腹腔镜宫角楔形切除术中,以垂体后叶素联合压脉带阻断子宫血流的止血辅助方式,相对于单纯应用垂体后叶素的止血辅助方式更有优势。

两种手术途径治疗宫角妊娠临床分析

目的探讨分别在腹腔镜下及经腹手术治疗宫角妊娠的方法。方法我院2003年1月～2008年1月确诊宫角妊娠36例,据病情分为A组:未破裂型16例,破裂型(出血量﹤800 ml)4例行腹腔镜下宫角楔形切除术及同时常规下在腹腔镜监护下行吸宫术;B组:破裂型(出血800～2 500 ml)16例行经腹宫角楔形切除术。结果A组20例患者均在腹腔镜下完成手术,无1例中转开腹,恢复顺利,无1例持续性异位妊娠。B组16例患者及时手术,经输血治疗后均如期恢复,存在2例持续性异位妊娠。A组术中出血(40.2±15.3)ml,B组术中出血(75.2±28.6)ml,A组出血量少于B组(P﹤0.01);手术时间A组(68.2±21.6)min,B组(80.9±20.2)min(P﹤0.05)。结论术前诊断明确,排除手术禁忌,腹腔镜下宫角楔形切除术治疗宫角妊娠是一种有效、安全、经济的方法。

腹腔镜治疗宫内合并输卵管间质部妊娠21例效果分析

目的:探讨宫内合并输卵管间质部妊娠的腹腔镜治疗及妊娠结局。方法:回顾性分析我院腹腔镜治疗IVF-ET后宫内合并输卵管间质部妊娠21例,比较采用宫角切开取胚术(16例)与宫角切除术(5例)的治疗及妊娠结局。结果:21例患者总的手术时间为58.5±6.3分钟,术中出血量52.9±5.8 ml,术后住院时间4.7±0.4天。两组患者在异位妊娠包块破裂率、手术时间、术中出血量、术后住院时间及足月产率差异均无统计学意义(P>0.05)。接受宫角切除术患者的异位妊娠包块平均直径大于接受宫角切开取胚术患者(2.5 cm vs 3.6 cm)。17例患者术后顺利分娩,除1例顺产外均行剖宫产,其中足月产11例,无一例患者发生子宫破裂。结论:腹腔镜治疗宫内合并输卵管间质部妊娠安全且妊娠结局良好。宫角切除术是目前主要的手术方式,但需注意子宫破裂;输卵管间质部妊娠包块较小时可选择行宫角切开取胚术。

间质妊娠:从生育外科协会登记处获得的结果

OBJECTIVE:To summarize management of interstitial pregnancy and its outcome among 32re ported cases in the world METHODS:From 1999to 2002,32c ases of inter-stitial pregnancy were reported to t he registry of the Society of Reproductive Surgeons.The participants completed a five -page questionnaire regarding when and how diagnosis was made,the characteristics of the pregnancy,treatment modalities,and subsequent reprodu ctive outcome.RE-SULTS:History of ipsilateral salpi ngectomy was encoun-tered in 37.5%of patients,and the di agnosis was made by ultrasound in 71.4%of the patients.Eight women were treated with methotrexate either sy stemically(n =4),lo-cally under ultrasound guidance(n =2),or under la-paroscopic guidance(n =2).Eleven patients were treated by laparoscopy and 13by laparotomy.Three patients failed systemic methotrexate treatment an d subsequently required surgery.Persistently elevated serumβhuman chorionic gonadotropin levels were found in on e patient after laparo-scopic cornual excision,and she was successfully treated with methotrexate.Fourteen cases(43.7%)of rupture of interstitial pregnancy were found.This included five cases(15.6%)of heterotopic pregnancy;all were t he results of in vitro fertilization,and all rupt ured at the time of diag-nosis.Subsequent pregnancywas ach ieved in ten patients.No uterine rupture was encountered d uring pregnancy or labor.CONCLUSION:Ipsilateral salpingectomy,previous ectopic pregnancy,and in vitro fertilization are predispos-ing factors for interstitial pregnancy.Contrary to previous belief,rupture of interstitial pre gnancy occurs relatively early in pregnancy.In selected patients,laparoscopiccornual excision is a viable treatme nt option.

输卵管间质部妊娠高危因素及诊治进展

输卵管间质部妊娠在异位妊娠中所占比例较小,但一旦破裂,可出现致命性大出血。其发病高危因素有输卵管病变、盆腔炎性疾病、盆腔炎性疾病病史、异位妊娠史、输卵管手术史等。输卵管间质部妊娠的术前诊断主要依靠超声检查或MRI,宫腔镜和腹腔镜是诊断输卵管间质部妊娠的最直接和最可靠的方法。除少数病例适合药物治疗外,腹腔镜手术是输卵管间质部妊娠治疗的主要方法,常用的有宫角切除及缝合术(宫角楔形切除术)和宫角切开及缝合术两种术式。