腹腔镜下输卵管妊娠保守性手术的手术时机探讨  

Surgical timing of tubal pregnancy conservative surgery under laparoscopy

作　　者：王晓平[1] 徐金花[1] 李开梅[1] 李英琼[1] 

机构地区：[1]东莞市黄江医院妇产科,广东523750

出　　处：《齐齐哈尔医学院学报》2016年第14期1805-1806,共2页Journal of Qiqihar Medical University

摘　　要：目的探讨输卵管妊娠腹腔镜保守性手术的时机。方法选择160例均有生育要求的未破裂型输卵管妊娠患者,随机分为对照组63例和观察组97例。对照组在诊断明确后即行腹腔镜手术,观察组在术前予MTX及米非司酮治疗,并严密观察患者生命体征及血清β-h CG浓度变化,择期手术治疗。比较两组在手术时间、术中出血量、术后血清β-h CG下降至正常时间及术后患侧输卵管的通常程度。结果观察组手术时间(40.1±9.6)min,明显短于对照组(60.2±11.5)min(P<0.01);观察组术中出血量(14.3±5.8)ml,明显少于对照组(61.2±9.2)ml(P<0.01);观察组血清β-h CG下降至正常时间(15.9±2.6)d,明显短于对照组(21.3±3.7)d(P<0.01);观察组术后输卵管通常率(83.7%),明显高于对照组(66.7%)(P<0.01)。结论术前给予MTX及米非司酮杀胚,血清β-h CG停止上升或下降,为未破裂性输卵管妊娠保守性手术的最佳时期。Objective To investigate the opportunity of laparoscopic conservative operation for tubal pregnancy. Methods A total of 160 patients with nonruptured tubal pregnancy and desired future pregnancy were enrolled into this study. They were divided into two groups,and treated with methotrexate（ MTX） ＋ laparoscopy（ combination group n = 97） and direct laparoscopic surgery（ control group,n = 63）. The duration of operation,the intraoperative blood loss,the duration of postoperative β-HCG level＇s down to normal and tubal patency were compared between groups. Results The average operation time in the combination group was（ 40. 1 ± 9. 6） min,shorter than that of the control group（ 60. 2 ± 11. 5） min; The intraoperative blood loss in the combination group was（ 14. 3 ± 5. 8） ml,less than that of the control group（ 61. 2 ± 9. 2） ml; the duration of postoperative HCG level＇s down to normal in combination group was（ 15. 9 ± 2. 6） d,shorter than that of control group（ 21. 3 ± 3. 7）d; The tubal patency in combination group was 83. 7%,higher than that of control group66. 7%. Conclusions The increasing stopping or decreasing of β-HCG level after using MTX and mifepristone,is the optimum period of laparoscopic conservative operation for tubal pregnancy.

关 键 词：输卵管妊娠 腹腔镜 人绒毛膜促性腺激素 

分 类 号：R714.221[医药卫生—妇产科学]