苏丽芬 洪宇

[摘要] 目的 比较腹腔镜与开腹手术治疗输卵管妊娠致腹腔内大出血的效果。 方法 回顾性分析2000年1月～2015年10月104例在普宁市妇幼保健院妇科住院、因输卵管妊娠致腹腔内大出血行手术治疗的患者的临床资料，其中66例行腹腔镜手术，38例行开腹手术，比较两组患者的治疗效果。 结果 腹腔镜组患者中原有3例因盆腔严重粘连、出血凶猛而中转开腹，其余均在腹腔镜下顺利完成，成功率为95.7%；两组均取得很好的临床疗效，无一例术中、术后并发症发生；与开腹组患者比较，腹腔镜组患者盆腹腔积血量明显较少，且手术时间明显较短（P均<0.05），在术中出血量、输血量方面，两组比较差异无统计学意义（P均>0.05）；腹腔镜组患者术后肛门排气时间、术后首次下床时间均短于开腹组（P均<0.05）；两组出院时血红蛋白水平、住院天数比较差异无统计学意义（P均>0.05）。 结论 与开腹手术比较，腹腔镜手术对腹腔内大出血的输卵管妊娠患者具有快速止血、手术时间短等优势，值得临床推广。

[关键词] 输卵管妊娠；腹腔出血；腹腔镜手术；开腹手术

[中图分类号] R714.22 [文献标识码] A [文章编号] 1674-4721（2016）03（b）-0081-03

[Abstract] Objective To compare the effect of laparoscopy and laparotomy in the treatment of fallopian pregnancy induced intra-abdominal bleeding. Methods Clinical data of 104 patients who were hospitalized in Maternal and Child Health Care Hospital of Puning City and were given surgical treatment due to fallopian pregnancy induced intra-abdominal bleeding from January 2000 to October 2015 were retrospectively analyzed.66 patients were given laparoscopy and 38 patients were given laparotomy.Curative effects were compared between the two groups. Results 3 patients in the laparoscopy group were changed to laparotomy due to severe adhesion of pelvic cavity and unstoppable bleeding，and others were successfully completed under laparoscopy，with the successful rate of 95.7%；The clinical curative effects were favorable in the two groups，without complications during the surgery and after the surgery；Compared with the patients in the laparotomy group，the volume of bleeding in the pelvic cavity in the patients in the laparoscopy group was significantly lower，and the surgery time was significantly shorter（all P<0.05）.In terms of volume of bleeding during surgery and volume of blood transfusion，there were no differences between the two groups of patients （all P<0.05）；Time of postoperative passage of gas and postoperative first off-bed activity in the patients in the laparoscopy group was better than that in the laparotomy group respectively（all P<0.05）；In terms of level of hemoglobin and length of stay upon discharge，there was no significant differences between the two groups of patients respectively（all P<0.05）. Conclusion Compared with laparotomy，laparoscopy has the advantages of fast hemostasis and short surgery time for the patients with fallopian pregnancy induced intra-abdominal bleeding，which is worthy of clinical promotion.

[Key words] Fallopian pregnancy；Abdominal bleeding；Laparoscopy；Laparotomy

异位妊娠是可危及生命的妇科常见病，其发生率为所有妊娠的1.3%～2%，以输卵管妊娠为主[1]。尽管近年来该病导致的死亡率明显降低，但仍占妊娠相关死亡总数的9%～13%[2-3]。腹腔镜术因其创伤小、失血少、术时短、恢复快等优势，已逐渐取代传统开腹手术，成为诊治异位妊娠的金标准。但对于异位妊娠病灶已发生破裂，腹腔内大出血的患者来说，腹腔内的出血量与患者的血流动力状态是衡量采用腹腔镜或开腹手术的重要标准。既往有学者报道腹腔镜手术对此类患者的可行性[4-7]，但纳入的患者数量较少，本研究拟采用病例对照研究方法比较腹腔镜与开腹手术治疗输卵管妊娠致腹腔内大出血、血流动力学不稳定患者的效果。……