吉林医学
吉林醫學
길림의학
JILIN MEDICAL JOURANL
2014年
22期
4857-4860
,共4页
输卵管妊娠%腹腔镜手术%开腹术%异位妊娠
輸卵管妊娠%腹腔鏡手術%開腹術%異位妊娠
수란관임신%복강경수술%개복술%이위임신
Tubal pregnancy%Laparoscopy%Laparotomy%Ectopic pregnancy
目的：比较腹腔镜与开腹保留输卵管手术治疗输卵管妊娠的临床效果。方法：对102例保守手术治疗输卵管妊娠的临床资料进行回顾性分析，其中腹腔镜手术治疗52例（腔镜组），开腹手术治疗50例（开腹组），两组病例均采取输卵管开窗术，并在输卵管系膜局部注射50mg甲氨喋呤，观察两组手术效果。结果：腔镜组术中出血量[（82.38±20.88）ml]与开腹组出血量[（82.38±20.88）ml]比较，差异有统计学意义（P<0.05）；腔镜组腹部手术切口长度[（2.44±0.36）cm]明显小于开腹组[（7.62±0.98）cm]，两者差异有统计学意义（P<0.05）；腔镜组术后曲马多镇痛用量[（253.85±122.41）mg]明显要少于开腹组[（528.00±152.92）mg]，其差异有统计学意义（P<0.05）；腔镜组患者术后首次肛门排气时间[（23.04±4.27）h]与开腹组[（29.64±5.28）h]比较，差异具有统计学意义（P<0.05）；腹腔镜组首次下床活动时间[（10.44±1.86）h]与开腹组[（27.97±3.11）h]比较，两者差异有统计学意义（P<0.05）；腔镜组住院时间[（4.83±1.46）d]明显短于开腹组[（8.36±2.35）d]，差异具有统计学意义（P<0.05）；腔镜组住院费用[（4.26±0.77）万元]明显高于开腹组[（2.79±0.410）万元]，两者差异有统计学意义（P<0.05）；腔镜组患者恢复日常工作所需时间[（13.75±2.19）d]明显短于开腹组[（18.64±5.47）d]，差异有统计学意义（P<0.05）；腔镜组患者术后3个月输卵管通畅率78.85%明显高于开腹组66.00%，两者差异有统计学意义（ P<0.05）。两组的手术时间、手术并发症发生率、血β-HCG降至正常时间、月经恢复时间及1.5年内同侧重复异位妊娠发生率比较差异无统计学意义（ P>0.05）。结论：腹腔镜和开腹保留输卵管手术均能有效治疗输卵管妊娠，但腹腔镜手术具有显著的微创效果，且能提高输卵管通畅率，非常适合有生育要求的女性。
目的：比較腹腔鏡與開腹保留輸卵管手術治療輸卵管妊娠的臨床效果。方法：對102例保守手術治療輸卵管妊娠的臨床資料進行迴顧性分析，其中腹腔鏡手術治療52例（腔鏡組），開腹手術治療50例（開腹組），兩組病例均採取輸卵管開窗術，併在輸卵管繫膜跼部註射50mg甲氨喋呤，觀察兩組手術效果。結果：腔鏡組術中齣血量[（82.38±20.88）ml]與開腹組齣血量[（82.38±20.88）ml]比較，差異有統計學意義（P<0.05）；腔鏡組腹部手術切口長度[（2.44±0.36）cm]明顯小于開腹組[（7.62±0.98）cm]，兩者差異有統計學意義（P<0.05）；腔鏡組術後麯馬多鎮痛用量[（253.85±122.41）mg]明顯要少于開腹組[（528.00±152.92）mg]，其差異有統計學意義（P<0.05）；腔鏡組患者術後首次肛門排氣時間[（23.04±4.27）h]與開腹組[（29.64±5.28）h]比較，差異具有統計學意義（P<0.05）；腹腔鏡組首次下床活動時間[（10.44±1.86）h]與開腹組[（27.97±3.11）h]比較，兩者差異有統計學意義（P<0.05）；腔鏡組住院時間[（4.83±1.46）d]明顯短于開腹組[（8.36±2.35）d]，差異具有統計學意義（P<0.05）；腔鏡組住院費用[（4.26±0.77）萬元]明顯高于開腹組[（2.79±0.410）萬元]，兩者差異有統計學意義（P<0.05）；腔鏡組患者恢複日常工作所需時間[（13.75±2.19）d]明顯短于開腹組[（18.64±5.47）d]，差異有統計學意義（P<0.05）；腔鏡組患者術後3箇月輸卵管通暢率78.85%明顯高于開腹組66.00%，兩者差異有統計學意義（ P<0.05）。兩組的手術時間、手術併髮癥髮生率、血β-HCG降至正常時間、月經恢複時間及1.5年內同側重複異位妊娠髮生率比較差異無統計學意義（ P>0.05）。結論：腹腔鏡和開腹保留輸卵管手術均能有效治療輸卵管妊娠，但腹腔鏡手術具有顯著的微創效果，且能提高輸卵管通暢率，非常適閤有生育要求的女性。
목적：비교복강경여개복보류수란관수술치료수란관임신적림상효과。방법：대102례보수수술치료수란관임신적림상자료진행회고성분석，기중복강경수술치료52례（강경조），개복수술치료50례（개복조），량조병례균채취수란관개창술，병재수란관계막국부주사50mg갑안첩령，관찰량조수술효과。결과：강경조술중출혈량[（82.38±20.88）ml]여개복조출혈량[（82.38±20.88）ml]비교，차이유통계학의의（P<0.05）；강경조복부수술절구장도[（2.44±0.36）cm]명현소우개복조[（7.62±0.98）cm]，량자차이유통계학의의（P<0.05）；강경조술후곡마다진통용량[（253.85±122.41）mg]명현요소우개복조[（528.00±152.92）mg]，기차이유통계학의의（P<0.05）；강경조환자술후수차항문배기시간[（23.04±4.27）h]여개복조[（29.64±5.28）h]비교，차이구유통계학의의（P<0.05）；복강경조수차하상활동시간[（10.44±1.86）h]여개복조[（27.97±3.11）h]비교，량자차이유통계학의의（P<0.05）；강경조주원시간[（4.83±1.46）d]명현단우개복조[（8.36±2.35）d]，차이구유통계학의의（P<0.05）；강경조주원비용[（4.26±0.77）만원]명현고우개복조[（2.79±0.410）만원]，량자차이유통계학의의（P<0.05）；강경조환자회복일상공작소수시간[（13.75±2.19）d]명현단우개복조[（18.64±5.47）d]，차이유통계학의의（P<0.05）；강경조환자술후3개월수란관통창솔78.85%명현고우개복조66.00%，량자차이유통계학의의（ P<0.05）。량조적수술시간、수술병발증발생솔、혈β-HCG강지정상시간、월경회복시간급1.5년내동측중복이위임신발생솔비교차이무통계학의의（ P>0.05）。결론：복강경화개복보류수란관수술균능유효치료수란관임신，단복강경수술구유현저적미창효과，차능제고수란관통창솔，비상괄합유생육요구적녀성。
Objective To explore and compare the clinical efficacies of preserving fallopian tube peritoneoscope surgery and traditional operation in treatment of tubal ectopic pregnancy. Method Retrospective analysis of 102 cases of conservative surgery for the treatment of tubal pregnancy clinical data,including 52 patients receiving laparoscopy( laparoscopy group)and 50 patients receiving laparotomy( laparot-omy group);two group were both treated by tubal fenestration with mesosalpinx local injection 50 mg methotrexate,then the result of opera-tion two groups were observed. Results There was significant difference in the amount of blood loss during operation between laparoscopy group[(82. 38 ± 20. 88)ml]and laparotomy group[(82. 38 ± 20. 88)ml](P<0. 05);the incision length of abdominal region in laparos-copy group[(2. 44 ± 0. 36)cm]was shorter than laparotomy group[(7. 62 ± 0. 98)cm]with significant difference(P<0. 05);consump-tion of tramadol after operation in laparoscopy group[(253. 85 ± 122. 41)mg]was less than laparotomy group[(528. 00 ± 152. 92)mg] with significant difference(P<0. 05);the first of anal exhausting time after operation in laparoscopy group[(23. 04 ± 4. 27)hours]was shorter than laparotomy group[(29. 64 ± 5. 28)hours]with significant difference(P<0. 05);the first of exercise time leaving bed after operation in laparoscopy group[(10. 44 ± 1. 86)hours]was shorter than laparotomy group[(27. 97 ± 3. 11)hours]with significant differ-ence(P<0. 05);the hospitalization time in laparoscopy group[(4. 83 ± 1. 46)days]was shorter than laparotomy group[(8. 36 ± 2. 35) days]with significant difference(P<0. 05);the hospitalization fee in laparoscopy group[(4. 26 ± 0. 77)million yuan]was lower than laparotomy group[( 2. 79 ± 0. 410 ) million yuan ] with significant difference(P<0. 05);the time of recovered daily work in laparoscopy group[(13. 75 ± 2. 19)days]was shorter than laparotomy group [(18. 64 ±5. 47)days]with significant difference(P<0. 05);the patency rate of fallopian tubes in laparoscopy group(78. 85%)was higher than laparotomy group(66. 00%)with significant difference(P<0. 05). There was no statistical difference between two groups in the operation time,postoperative complications,the time of the blood β-human chorionic gonadotropin(β-HCG)decreased to normal range,the time of menstruation recovery and the rate of ipsilateral repeat ectopic pregnancy within 1. 5 yearˊs after surgery( P>0. 05 ) . Conclusion preserving fallopian tube laparoscopy and traditional operation in treatment of tubal ectopic pregnancy are effective;Moreover, laparoscopy is very suitable to the patient who desires for fertility,as a result of its micro-invasion and can enhance the patency rate of fal-lopian tubes.
