腹腔镜手术治疗妊娠合并卵巢囊肿的可行性和安全性及其对妊娠结局的影响  

The feasibility, safety and effect of laparoscopic surgery on ovarian cyst during pregnancy

作　　者：郝万明[1] 张军[2] 魏炜[2] 李燕娜[2] 张大伟[2] 

机构地区：[1]河北省张家口市怀来县医院妇产科,075400 [2]首都医科大学附属北京安贞医院妇产科

出　　处：《中国医药》2014年第9期1344-1346,共3页China Medicine

摘　　要：目的：探讨腹腔镜手术治疗妊娠合并卵巢囊肿的可行性和安全性及其术后妊娠结局。方法选取14例于妊娠期接受无气腹腹腔镜手术治疗的妊娠合并卵巢囊肿患者作为观察组，同期40例非妊娠期因卵巢囊肿行腹腔镜手术治疗的患者作为对照组（包括无气腹腹腔镜手术17例、气腹腹腔镜手术23例）。收集并整理患者的临床资料，分析手术适应证、手术方法、妊娠孕周（即手术时机）、卵巢囊肿大小、手术时间、术中出血量、并发症及母胎结局。结果14例入组妊娠患者均为单侧卵巢囊肿，均于妊娠期接受了无气腹腹腔镜手术治疗，40例非妊娠患者中有17例接受无气腹腹腔镜治疗，23例接受气腹腹腔镜治疗，手术均顺利结束，无中转开腹，术中术后无并发症发生。妊娠组14例手术时间为45～90 min，平均（54±16）min，术中出血量为20～100 ml，平均（58±29）ml；对照组40例，无气腹腹腔镜手术17例，气腹腹腔镜手术23例，其中无气腹组手术时间为20～110 min，平均（49±22）min，术中出血量为10～100 ml，平均（59±33） ml，气腹组手术时间为20～120 min，平均（54±28） min，术中出血量为5～150 ml，平均（64±43） ml。2组之间上述指标比较差异均无统计学意义（ P＞0．05）。观察组有13例患者在腹腔镜手术后继续妊娠至孕足月，新生儿体质量及Apgar评分正常，1例术后自然流产，手术后成功继续妊娠率为92．9％（13/14）。结论在严格控制手术适应证并小心操作的情况下在孕期行腹腔镜手术治疗妊娠合并卵巢囊肿是安全可行的，尤其是无气腹腹腔镜治疗妊娠合并卵巢囊肿，不仅可以获得良好的手术效果，还可以获得良好的妊娠结局。Objective To analyze the feasibility , safety and effect of laparoscopic surgery treating ovarian cyst during pregnancy.Methods The surgical indications, operation methods, operation time, ovarian cyst size, operation time, amount of bleeding , complications and the pregnancy outcomes were studied retrospectively in the 14 cases who underwent gasless laparoscopic surgery treatment of pregnancy ;40 cases of the same period of preg-nancy undergoing laparoscopic surgery for ovarian cyst were as a control group .Results The 14 cases of the ob-servation group were unilateral ovarian cyst and they had gasless laparoscopic surgery treatment .23 non-pregnant patients also received this treatment .17 patients received gasless laparoscopy surgery .All the operations were suc-cessfully concluded without laparotomy , intraoperative and postoperative complications .Compared with the control group, time of surgery and amount of bleeding of the observation group were 45-90 min [average （54 ±16） min] and 20-100 ml [average （58 ±29） ml].In the control group, time of surgery and amount of bleeding of the gas-less laparoscopic surgeries were 20-110 min [average （49 ±22） min] and 10-100 ml [average （59 ±33） ml];the laparoscopic surgeries were 20-120 min [average （54 ±28） min]and 5-150 ml [average （64 ±43） ml].But there were no significant differences among the groups （P〉0.05）.In observation group, there were 13 cases who continued the pregnancy to childbirth after laparoscopic surgery and got good pregnancy outcomes with normal birth weight and neonatal Apgar score .1 patient had spontaneous abortion .The ongoing pregnancy rate was 92.9%（13/14）.Conclusions For strictly selected cases and carefully operation , laparoscopic surgery in ovarian cyst during pregnancy is safe and feasible in the treatment of pregnancy with ovarian cyst , especially the gasless laparoscopy . In addition to good operation effect , this method can also get good pregnancy outcomes .

关 键 词：卵巢囊肿 腹腔镜 妊娠 

分 类 号：R71[医药卫生—妇产科学]