CAJ | 학술논문

目的：探讨非气腹腹腔镜手术治疗妊娠合并卵巢良性肿瘤的可行性。方法2006年1月～2013年6月对45例妊娠合并卵巢良性肿瘤行非气腹腹腔镜手术，硬膜外阻滞麻醉下按照非气腹腹腔镜手术常规操作，一般行肿瘤剥除术，肿瘤巨大、缺乏或剩余极少正常卵巢组织或已扭转坏死行患侧附件切除术。结果45例均顺利完成非气腹腹腔镜手术，无中转开腹和并发症发生。42例行卵巢肿瘤剥除术，3例行患侧附件切除术。手术时间25～90 min，（40．7±14．9） min；术中出血量10～80 ml，（27．3±16．6）ml；住院时间3～8 d，（4．5±1．3）d。术前、术中、术后动脉血pH值、二氧化碳分压（blood pressure carbon dioxide， PaCO2）、氧分压（blood oxygen partial pressure，PaO2）均无统计学差异（F＝0．00，P＝0．999；F＝2．21， P＝0．114；F＝0．60，P＝0．555），碳酸氢根（bicarbonate，HCO3-）和血氧饱和度（blood oxygen saturation，SpO2）虽有统计学差异（F＝14．96，P＝0．000；F＝9．45，P＝0．000），但无临床意义，均在正常范围内。术前、术中、术后监测胎心率均在正常范围内。术前、术中、术后心率和血压比较无统计学差异（P＞0．05）。术后病理：成熟性囊性畸胎瘤25例（55．6％），浆液性囊腺瘤6例（13．3％），黏液性囊腺瘤4例（8．9％），输卵管系膜囊肿3例（6．7％），子宫内膜异位囊肿2例（4．4％），黄体囊肿5例（11．1％）。术后随访无自然流产，43例妊娠至足月分娩，新生儿出生体重和Apgar评分未见异常，2例术后要求放弃胎儿。结论非气腹腹腔镜手术治疗妊娠合并卵巢良性肿瘤期是安全可行的。
목적：탐토비기복복강경수술치료임신합병란소량성종류적가행성。방법2006년1월～2013년6월대45례임신합병란소량성종류행비기복복강경수술，경막외조체마취하안조비기복복강경수술상규조작，일반행종류박제술，종류거대、결핍혹잉여겁소정상란소조직혹이뉴전배사행환측부건절제술。결과45례균순리완성비기복복강경수술，무중전개복화병발증발생。42례행란소종류박제술，3례행환측부건절제술。수술시간25～90 min，（40．7±14．9） min；술중출혈량10～80 ml，（27．3±16．6）ml；주원시간3～8 d，（4．5±1．3）d。술전、술중、술후동맥혈pH치、이양화탄분압（blood pressure carbon dioxide， PaCO2）、양분압（blood oxygen partial pressure，PaO2）균무통계학차이（F＝0．00，P＝0．999；F＝2．21， P＝0．114；F＝0．60，P＝0．555），탄산경근（bicarbonate，HCO3-）화혈양포화도（blood oxygen saturation，SpO2）수유통계학차이（F＝14．96，P＝0．000；F＝9．45，P＝0．000），단무림상의의，균재정상범위내。술전、술중、술후감측태심솔균재정상범위내。술전、술중、술후심솔화혈압비교무통계학차이（P＞0．05）。술후병리：성숙성낭성기태류25례（55．6％），장액성낭선류6례（13．3％），점액성낭선류4례（8．9％），수란관계막낭종3례（6．7％），자궁내막이위낭종2례（4．4％），황체낭종5례（11．1％）。술후수방무자연유산，43례임신지족월분면，신생인출생체중화Apgar평분미견이상，2례술후요구방기태인。결론비기복복강경수술치료임신합병란소량성종류기시안전가행적。
Objective To investigate the feasibility, safety and effect of gasless laparoscopic surgery in the treatment of benign ovarian tumors during pregnancy. Methods Clinical data of 45 pregnant women with benign ovary tumors undergoing gasless laparoscopic surgery from January 2006 to June 2013 were studied retrospectively.Most of the cases were given oophorocystectomy. Adnexectomy was performed for the large sized lesions, lacking of or remaining few normal ovarian tissue, or ovarian cyst torsion. Results All the 45 cases were successfully treated by gasless laparoscopic surgery.No perioperative and postoperative complications were observed.There were 42 cases receiving ovarian tumor resection while 3 cases receiving simple salpingo-oophorectomy.The mean operation time was (40.7 ±14.9) min (25-90 min), the mean blood loss was (27.3 ±16.6) ml (10 -80 ml), and the mean hospitalization time was (4.5 ±1.3) days (3-8 days).At pre-, peri-, and post-operative time, the blood pH value, blood pressure carbon dioxide (PaCO2), and blood oxygen partial pressure (PaO2) showed no statistical difference (F=0.00,P=0.999;F=2.21, P=0.114;F=0.60,P=0.555), and blood bicarbonate (HCO3-) and blood oxygen saturation (SpO2) showed statistical difference but no clinical significance (F=14.96,P=0.000;F=9.45,P=0.999), all of which were in the normal range.The fetal heart rates were all in the normal range.Pathological diagnoses were ovarian mature cystic teratoma in 25 cases (55.6%), serous cystadenoma in 6 cases (13.3%), mucinous cystadenoma in 4 cases (8.9%), mesosalpinx cyst in 3 cases (6.7%), endometrial cyst in 2 cases (4.4%), and luteal cyst in 5 cases (11.1%).No spontaneous abortion was found in post-operational follow-up.Term delivery was obtained in 43 cases, with normal fetal weight and the Apgar scores.Two cases gave up the pregnancy in the postoperative period. Conclusion Gasless laparoscopic surgery for benign ovarian tumors during pregnancy is safe and feasible.