腹腔镜治疗异位妊娠合并失血性休克的临床探讨  

Laparoscopy in the management of ectopic pregnancy with hemorrhagic shock

作　　者：佐满珍[1] 陶静[1] 赵学英[1] 杨慧琼[1] 彭华[1] 

机构地区：[1]湖北宜昌市第一人民医院妇产科,宜昌443000

出　　处：《中国微创外科杂志》2003年第6期505-506,共2页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的　探讨异位妊娠合并失血性休克行腹腔镜治疗的可行性。　方法　对 35例异位妊娠伴有失血性休克 ,血压在 6 0 / 30mmHg以上 ,B超提示腹腔内失血量 <2 0 0 0ml,在建立良好输液通道及血源准备充分情况下行腹腔镜手术。　结果 2 8例行自体血回收 (80 % ) ,回输血量 (788 3± 2 35 7)ml;输异体血 9例 (2 5 7% ) ,输血量 (5 33 3± 96 4 )ml。术中行输卵管切除 2 3例 ,输卵管病灶清除 6例 ,病灶清除联合局部注射甲氨蝶呤 (MTX) 6例。 1 3例要求生育同时行宫腔通液 ,其中 3例输卵管积水行造口术。无中转开腹病例。术后病率 1 4 3% (5 / 35 ) ,2例腹腔引流管创口延期愈合。术后住院 3天～ 8天 ,平均 4天。　结论　异位妊娠合并失血性休克在一定条件下行腹腔镜手术是安全的 ,可避免自体血回收的污染 ,有效减少异体血输入的风险。Objective To study the feasibility of laparoscopic procedures in the treatment of ectopic pregnancy with hemorrhagic shock. Methods Laparoscopic procedures were carried out in 35 patients with ectopic pregnancy concurrent with hemorrhagic shock. Patients' blood pressures were all above 60/30 mmHg, and B-ultrasonography revealed the intra-abdominal blood loss < 2000 ml. Operations were performed under fully fluid infusion and preparation of blood transfusion. Results Out of the 35 cases, autotransfusion was adopted in 28 cases (80.0%), with a transfusion amount of (788.3±235.7) ml, whereas allogeneic blood transfusion was used in 9 cases (25.7%), with a transfusion amount of (533.3±96.4) ml. Salpingectomy was performed in 23 cases, tubal lesion clearance in 6 cases, and lesion clearance with injection of methotrexate (MTX) in 6 cases. Of the 35 patients, 13 patients with a demand of preserving fertility underwent hydrotubation, and 3 of them also underwent salpingostomy because of hydrosalpinx. Conversions to open surgery were required in no cases. Postoperative incidence of pyrexia was 14.3% (5 of 35), and delayed healing of drainage wound took place in 2 cases. Conclusions Laparoscopic procedures in the treatment of ectopic pregnancy with hemorrhagic shock are safe under certain conditions. They effectively prevent the contamination during the recollection of autoblood and the risk of allogeneic blood transfusion.

关 键 词：异位妊娠 失血性休克 合并症 腹腔镜 治疗 临床分析 

分 类 号：R714.22[医药卫生—妇产科学]