休克型异位妊娠术式选择的影响因素探讨

Research on factors affecting operative approach of raptured ectopic pregnancy with shock

摘要:

目的 探讨休克型异位妊娠手术方式选择的影响因素。方法 对2005年1月~2012年12月134例休克型异位妊娠患者的术前血压、脉搏、腹腔内出血量，盆腹腔手术史、术前准备时间、手术时间、住院时间、手术费用、术后持续性宫外孕发生率及手术医生的腹腔镜手术技术的熟练程度等临床资料进行回顾性分析。结果 腹腔镜手术组（A组）与开腹手术组（B组）患者的一般情况差异无显著性；A组共64例（52.24％）进行了腹腔镜手术，均由具备熟练的腹腔镜手术技术者完成。B组70例（47.76％）进行开腹手术，50例由不具备腹腔镜操作技术的医师完成，20例由具有腹腔镜操作技术的医师完成；A组与B组有腹部手术史的比例分别为15.63％和25.71％，差异无显著性（P >0.05）；术前最低收缩压、最低舒张压、腹腔内出血量、术中出血量、术前准备时间、手术时间和术后持续性宫外孕发生率，差异无显著性（P >0.05），A组术后住院时间为（4.41±0.92）d明显短于B组（6.49士1.47）d，差异有显著性（P <0.05），A组治疗费用高于B组，差异有显著性（P <0.05）。结论 手术医生的腹腔镜手术熟练程度是影响休克型异位妊娠术式选择的重要决定因素，手术费用问题也影响了手术方式的的选择，良好的腹腔镜手术配合麻醉监护是手术成功的重要保障。

Abstract:

【Objective】 To study the factors affecting the operative approach of the patients with ruptured ectopic pregnancy with shock. 【Methods】 Seventy-two women (group A) with ectopic pregnancy underwent operative laparoscopy and sixty women (group B) underwent laparotomy. These patients were ectopic pregnancy with shock and intraperitoneal hemorrhage more than 800ml. The clinical data of perioperative periods in two groups were analyzed. 【Results】 All patients were tube pregnancies. The blood loss ranged from 800 mL to 3 000 mL. Seventy-two (53.73%) were treated by laparoscopy, the operation performed by the experienced laparoscopists; Sixty (46.27%) were operated on under laparotomy by the doctor who had unexperienced laparoscopists. Group A and group B with the history of laparotomy were 15.63％ and 25.71%, the difference was not significant (P >0.05). The general data in two groups were not significant. The differences of blood pressure, intraabdominal blood loss, operative blood and operative time between two groups were not significant (P >0.05). The time of hospital stay was shorter in group A than in group B, the cost was higher in group A than in group B, the difference was significant (P<0.05). All patients had no perioperative complications. 【Conclusion】 It is the main factor affecting the operative approach if the doctors were experienced laparoscopists. The cost maybe also affect the operative approach. With the aid of optimal anesthesia, advanced cardiovascular monitoring and experienced surgical teams, operative laparoscopy is of recognized advantages over laparotomy and is feasible in women with ruptured ectopic pregnancy and significant haemoperitoneurm.