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腹腔镜下垂体后叶素联合线圈套扎治疗输卵管间质部妊娠的临床观察
Clinical observation of pituitrin combined with laparoscopic endoloop ligation for the treatment of interstitial tubal pregnancy

微创医学 201503期 页码:304-306,301

作者机构:(广西壮族自治区民族医院妇产科,南宁市 530001)

基金信息:作者简介:韦艳芬(1980~),女,硕士,主治医师,研究方向:妇科内镜。(收稿日期:20150219修回日期:20150417)

DOI:10.11864/j.issn.1673.2015.03.14

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目的 探讨腹腔镜下垂体后叶素联合线圈套扎行部分输卵管切除治疗输卵管间质部妊娠的临床疗效。方法 将输卵管间质部妊娠135例按手术操作前病灶部位是否注射垂体后叶素分成2组,研究组68例,对照组67例。研究组在腹腔镜下经腹于子宫正常肌层与病灶交界处注入垂体后叶素6 U后,凝切输卵管峡部,切断输卵管系膜及血管至宫角,清除病灶后线圈套扎包块基底部,于线结上0.5 cm将输卵管部分切除,于子宫角注射甲氨蝶呤25 mg预防持续性异位妊娠。对照组行上述操作前不用垂体后叶素。观察两组手术时间、术中出血量、术后血HCG转阴时间及持续性异位妊娠发生率等情况。结果 研究组手术时间、术中出血量、术后血HCG转阴时间均明显短于对照组,持续性异位妊娠发生率低于对照组,差异有统计学意义;研究组用垂体后叶素后10 min、20 min血压与麻醉后用垂体后叶素前比较差异有统计学意义(P<0.05),用药后30 min血压差异无统计学意义(P>0.05)。结论 腹腔镜下垂体后叶素联合线圈套扎行部分输卵管切除治疗间质部妊娠是一种安全、简便的治疗方法,具有较高的临床实用价值。
Objective To evaluate the efficacy of partial salpingectomy by laparoscopic endoloop ligation combined with pituitrin in interstitial tubal pregnancy. Methods1 35 patients with interstitial tubal pregnancy were divided into study group (n=68) and control group (n=67) depending on whether the lesion was injected with pituitrin before operation. In the study group, the junction of normal myometrium and the lesion was transabdominally injected with pituitrin 6 U under laparoscopyguided, and then the isthmus of fallopian tube was coagulated and divided. The mesosalpinx and vessels were dissected, which was not beyond the uterine horn. The fundus of the mass was ligated with an endoloop after removal of the lesion. Partially resection was performed in the fallopian tube 0.5cm above the knot. The uterine horn was injected with methotrexate 25mg for prevention from persistent ectopic pregnancy. The patients in the control group underwent the operation without pituitrin injection. Operative duration, intraoperative blood loss, postoperative HCG clearance time and the incidence of persistent ectopic pregnancy were assessed in two groups. Results The operative duration, intraoperative blood loss, postoperative HCG clearance time were shorter, and the incidence of persistent ectopic pregnancy was lower in the study group compared to the control group, which had a statistically difference.The blood pressure after anesthesia had a difference from that at 10 min and 20 min after pituitrin administration (P<0.05), but had no difference from that at 30 min after pituitrin administration (P>0.05). Conclusions The partial salpingectomy by pituitrin combined with laparoscopic ligation with endoloops is a safe and easy approach for interstitial tubal pregnancy.
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