论文部分内容阅读
目的:探讨选择适当手术时机在输卵管妊娠腹腔镜保守性手术中的重要性。方法:选择52例输卵管妊娠患者均有生育要求,分为A组28例在诊断明确后即行腹腔镜下输卵管开窗取胚术;B组24例为术前予MTX及米非司酮治疗,并严密观察患者生命体征与血清β-HCG的变化,在保证患者生命体征稳定的前提下期待治疗,择期行腹腔镜手术治疗。比较两组在手术时间、术中出血量、术中电凝止血时间以及术后患侧输卵管的通畅程度。结果:手术时间B组(38.5±8.7)min,A组(64.3±11.2)min(P<0.05);术中出血量B组(11.4±3.1)ml,A组(59.3±12.1)ml(P<0.05);术中患侧输卵管创面电凝止血时间B组(2.3±0.6)min,A组(15.6±6.8)min(P<0.05);B组术后输卵管通畅率为45.8%(11/24),A组为25.0%(7/28)。结论:在患者没有出现危及生命的腹腔内出血的前提下,以保留患侧输卵管功能为最终目的的治疗,并无诊断明确后即行腹腔镜保守性手术的必要;术前予临床中对异位妊娠常规的药物治疗,并严密监测患者病情变化,选择合适的手术时机才能达到预定的治疗目的。
Objective: To explore the importance of selecting the appropriate timing of surgery in laparoscopic conservative surgery for tubal pregnancy. Methods: Select 52 cases of tubal pregnancy patients have fertility requirements, divided into A group of 28 cases in the diagnosis of clear laparoscopic tubal window embryo surgery; B group of 24 patients preoperative MTX and mifepristone treatment, And closely observe the patient’s vital signs and serum changes of β-HCG, expectant treatment under the premise of ensuring the stability of vital signs in patients, elective laparoscopic surgery. The operation time, intraoperative blood loss, intraoperative coagulation time and postoperative tubal patency were compared between the two groups. Results: The operative time in group B was (38.5 ± 8.7) min, in group A (64.3 ± 11.2) min (P <0.05), in group B was 11.4 ± 3.1 and in group A was 59.3 ± 12.1 (P <0.05). The time of tubal patency in group B was 45.8% (11 / 24), A group was 25.0% (7/28). Conclusion: In patients with no life-threatening intra-abdominal hemorrhage premise, in order to retain the function of the tubal function of the affected side for the ultimate goal of treatment, there is no diagnosis after laparoscopic conservative surgery necessary; preoperative clinical to ectopic pregnancy Conventional drug therapy, and closely monitor the patient’s condition changes, select the appropriate timing of surgery to achieve the intended treatment.