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目的探讨妊娠晚期妇科腹腔镜手术的可行性。方法回顾性分析2009~2015年北京大学第一医院妇产科收治的4例晚孕期因附件包块住院、行腹腔镜手术治疗患者的临床资料,并随访其妊娠结局和新生儿情况。结果 4例患者的孕周为28+2~31+5周,临床表现均为急腹症,疑诊附件包块扭转而行腹腔镜手术,病理诊断为3例输卵管系膜囊肿扭转坏死,1例为增大坏死的卵巢。术后出现宫缩予硫酸镁、吲哚美辛等保胎治疗成功,未发生手术相关合并症。4例患者均足月分娩,3例因产科因素行剖宫产,1例阴道顺产,新生儿无窒息。随访6周~6年,患者月经正常、肿物无复发,小儿发育良好。结论晚孕期腹腔镜手术风险相对较大,对于因附件包块而致急腹症的患者,在有条件的医疗机构,由有经验的内镜医生施术,不失为一种治疗方法。
Objective To investigate the feasibility of gynecological laparoscopic surgery in late pregnancy. Methods The clinical data of 4 patients with obstetric and gynecological diseases admitted to Peking University First Hospital from 2009 to 2015 in the first trimester of pregnancy were analyzed retrospectively. The clinical data of patients undergoing laparoscopic surgery were retrospectively analyzed. The pregnancy outcome and neonatal status were followed up. Results The gestational age of the 4 patients was 28 + 2 ~ 31 + 5 weeks. The clinical manifestations were all acute abdomen. The suspected appendages were reversed and laparoscopically operated. The pathological diagnosis was 3 cases of tubal mesangial cyst torsion and necrosis, 1 Example for increasing necrosis of the ovary. After uterine contractions to magnesium sulfate, indomethacin and other miscarriage treatment success, no surgery-related complications. All 4 patients were given full-term delivery, 3 were cesarean because of obstetric reasons, 1 was vaginal birth, and the newborn had no asphyxia. Follow-up 6 weeks to 6 years, normal menstruation, no recurrence of tumor, children developed well. Conclusions The risk of laparoscopic surgery in late pregnancy is relatively high. Patients with acute abdomen caused by mass of appendix may be treated by experienced endoscopists in qualified medical institutions.