腹腔镜与开腹手术治疗妊娠期附件包块效果及妊娠结局的比较分析  

Comparative analysis of laparoscopy and laparotomy of adnexal masses in pregnancy for the clinical data of perioperative period and the outcome of the pregnancy

作　　者：阳艳军[1] 冷金花[1] 郎景和[1] 刘珠凤[1] 孙大为[1] 朱兰[1] 樊庆泊[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院妇产科,北京100730

出　　处：《中国实用妇科与产科杂志》2006年第3期187-190,共4页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的评价妊娠期腹腔镜附件手术的效果及安全性。方法2000年4月至2005年9月将北京协和医院妇科妊娠期腹腔镜附件手术17例(早孕期3例,中孕期14例)列为研究组,同期同孕周范围开腹附件手术19例(早孕期2例,中孕期17例)列为对照组,比较两组附件手术期情况及妊娠结局。结果早孕期研究组3例术后孕期顺利,足月分娩。中孕期两组患者在术前情况、手术方式和术后病理等方面差异无显著性(P>0·05)。两组平均手术时间、术后出现宫缩例数、剖宫产率和新生儿体重差异均无显著性(P>0·05);术中平均出血量、术后疼痛率、镇痛药用药率、平均应用抗生素时间及平均术后住院日差异有显著性意义(P<0·05)。两组新生儿均无畸形和窒息。结论在正确掌握妊娠期腹腔镜附件手术指征的前提下,腹腔镜术式对比开腹术式不增加术中和术后并发症,并具有术中出血少,术后疼痛轻,用药少,住院时间短的优势。Objective To evaluate the efficiency, safety and pregnancy outcome of laparoscopic surgery on adnexal masses in pregnancy. Methods From April 2000 to September 2005,17 cases with adncxal masses in pregnancy treated by laparoscopy were analyzed as the study group,while 19 cases with adnexal masses in pregnancy treated by laparotomy as the control group. The two groups were compared in terms of the clinical data of perioperative period and outcome of pregnancy. Results Three patients during the first trimester of pregnancy had an uneventful pregnancy and full-term delivery. The demography ,operative procedures and pathologic findings were similar in the two groups during the second trimester （P 〉 0. 05 ）. The mean operating time in the laparoscopy group （51 minutes） was insignificantly shorter than that in the laparotomy group （63 minutes）（P 〉 0. 05 ）;blood loss of 25ml in laparoseopy group was significantly less than 51ml in the laparotomy group（P 〈 0. 05 ）. The rate of postoperative pain was significantly less in laparoscopy（7%, 1/14） than in laparotomy（47%, 8/17 ）（ P 〈 0. 05 ）. Postoperative anodyne therapy, antibiotic therapy and hospital stay were significantly less in laparoscopy group than in laparotomy group（43% vs 100% ,2. 2 vs 3.5days,3.2 vs 6. 0 days） （P 〈0. 05） ; postoperative uterine contraction was observed in no patient in the laparoscopy group and 3 patients in control. The caesarean section rates and the neonatal weight were similar in the two groups（ P 〉 0. 05 ）. No newborn had asphyxia and anomaly in the two groups. Conclusion Laparoscopic surgery for adnexal masses in pregnancy is feasible and safe,and it has the advantage of less intraoperative blood loss, reduced postoperative pain and shorter postoperative hospital stay and has no adverse effects on pregnancy outcome.

关 键 词：腹腔镜手术 附件包块 妊娠 

分 类 号：R71[医药卫生—妇产科学]