腹腔镜手术治疗妊娠合并卵巢囊肿蒂扭转26例报告  

Experience of 26 Cases of Laparoscopic Surgery for Pedicle Torsion of Ovarian Cyst with Pregnancy

作　　者：孙媛媛[1] 汤丽荣[1] 

机构地区：[1]首都医科大学附属北京妇产医院妇科,北京100006

出　　处：《中国微创外科杂志》2017年第12期1091-1093,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜手术治疗妊娠合并卵巢囊肿蒂扭转的经验。方法 2009年1月~2016年12月对26例妊娠合并卵巢囊肿蒂扭转急诊行腹腔镜手术,根据术中情况,腹腔镜下行囊肿剥除术或患侧附件切除术。术后早期妊娠患者黄体酮20~40 mg肌肉内注射,1次/d,连续3 d;中晚期妊娠患者硫酸镁静脉滴注,5 g/d,连续3 d。通过患者再次入院记录、门诊或电话随访妊娠结局。结果 26例均完成腹腔镜手术。术中发现11例卵巢坏死行患侧附件切除术,其余15例行患侧卵巢肿物剥除术。手术时间20~60 min,平均47.8 min。术中出血10~400 ml,平均88.8 ml。住院时间2~16 d,平均5.8 d。术后21例(80.8%)保胎治疗。术后26例均未出现流产、早产症状,继续妊娠至足月分娩,13例顺产,13例剖腹产;新生儿出生后1、5 min Apgar评分8~10分。结论腹腔镜手术治疗妊娠合并卵巢囊肿蒂扭转对妊娠是安全的,但对于大囊肿、妊娠晚期患者手术困难。Objective To investigate the experience of laparoscopic surgery for pedicle torsion of ovarian cyst with pregnancy. Methods A retrospective analysis was made on 26 cases of pregnancy complicated with pedicle torsion of ovarian cyst receiving emergency laparoscopic surgery from January 2009 to December 2016 in our hospital. After the establishment of pneumoperitoneum, laparoscopic cyst dissection or accessory resection of the affected side was performed according to intraoperative conditions. Patients with early pregnancy were given progesterone 20 - 40 mg intramuscular injection, once a day for 3 days. Patients with late pregnancy were given intravenous drip of magnesium sulfate, 5 g daily for 3 days. The pregnancy outcome was recorded by readmission records, outpatient visits, or telephone follow-ups. Results Laparoscopic surgery was performed in all the 26 patients. During operation, 11 patients with ovarian necrosis underwent affected side resection, and the remaining 15 patients underwent enucleation of the affected ovary. The operation time was 20 - 60 min （average, 47.8 min）. The intraoperative bleeding was 10 -400 ml （average, 88. 8 m l ） . The hospitalization time was 2 - 16 d （ average, 5.8 d） . There were 21 cases of postoperative tocolytic therapy （80. 8% ） . All the 26 patients had no symptoms of miscarriage or premature delivery. They continued to term delivery, including 13 cases of spontaneous labor and 13 cases of caesarean section. The newborns were healthy, with 1- and 5-min Apgar scores of 8 - 10 points. Conclusions It is safe to treat the pregnancy complicated with pedicle torsion of ovarian cyst by laparoscopic surgery. Surgery is difficult for large cysts and late pregnancy.

关 键 词：妊娠 卵巢囊肿蒂扭转 妊娠结局 

分 类 号：R713.8[医药卫生—妇产科学]