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目的:探讨腹腔镜在异位妊娠严重腹腔内出血中的应用价值。方法:回顾性分析该院2005年5月～2008年5月256例经腹腔镜治疗的各种异位妊娠的临床资料。腹腔内出血在1000ml以上或在短时间内出血>400ml,出现休克或休克代偿者31例为研究组,其余225例为对照组。分析两组患者的围手术情况。结果:两组患者平均年龄、孕产次比较,差异均无统计学意义(P>0.05)。输卵管破裂、流产病例的比例分别为83.87%、16.13%与14.22%、42.67%,差异有统计学意义(P<0.01)。研究组腹腔内出血量比对照组显著性增加(P<0.01)。研究组中无输卵管线形切开病例,对照组中输卵管切除与线形切开比例分别为56.44%、43.56%,两组比较差异有统计学意义(P<0.01)。但两组患者术中出血、手术时间比较差异无统计学意义。均未发生与穿刺、气腹及全麻有关的并发症。结论:严密的心电、血氧监护,有效的抗休克治疗,熟练的腹腔镜操作技术是顺利完成手术的重要保证。
Objective: To investigate the value of laparoscopy in severe intra-abdominal hemorrhage with ectopic pregnancy. Methods: A retrospective analysis of the hospital from May 2005 to May 2008 256 cases of laparoscopic treatment of various ectopic pregnancy clinical data. Intraperitoneal hemorrhage in more than 1000ml or bleeding in a short time> 400ml, shock or shock compensatory 31 cases of the study group, and the remaining 225 cases of control group. Analysis of the two groups of patients perioperative situation. Results: There was no significant difference between the two groups in terms of average age and motherhood (P> 0.05). The incidence of tubal rupture and abortion were 83.87%, 16.13% and 14.22%, 42.67%, respectively, with significant difference (P <0.01). The amount of intra-abdominal bleeding in the study group was significantly higher than that in the control group (P <0.01). In the study group, there was no cases of linear tubal incision. The proportion of tubal resection and linear incision in the control group were 56.44% and 43.56% respectively, with significant difference between the two groups (P <0.01). However, there was no significant difference between the two groups in intraoperative bleeding and operation time. No complications related to puncture, pneumoperitoneum and general anesthesia occurred. Conclusions: Tight ECG, blood oxygen monitoring, effective anti-shock therapy and skilled laparoscopic operation technique are the important guarantees for successful operation.