【摘要】 目的通过对腹腔镜与开腹手术治疗异位妊娠的近远期疗效分析,比较两种术式的优缺点,探讨相关的几个问题。方法回顾性分析2001年1月￣2003年12月手术治疗的异位妊娠患者309例,其中腹腔镜组200例,开腹组109例,比较两组的手术时间、术中出血量、输血率、术后肛门排气时间、镇痛剂和抗生素应用,以及住院日、住院费用、恢复工作和生活情况等。结果两组患者的手术时间、住院日差异无显著性(72.5±29.62vs75.48±29.02,8.68±3.48vs8.05±2.14,P>0.05),而术中出血量、输血率、保留尿管天数、肛门排气时间、术后镇痛剂、抗生素应用、住院总费用、恢复工作和生活情况两组相比差异有显著性(P<0.001)。腹腔镜组总费用明显高于开腹组(7606.15±1354.58vs6310.14±1917.19,P<0.05),但因其术后疗效肯定、对整个机体影响轻微而被患者接受,目前已经成为该院异位妊娠治疗的首选手术方式。结论腹腔镜手术具有创伤小、切口美观、恢复快、临床疗效肯定等优点,已逐渐替代开腹手术,在有条件的地区,成为异位妊娠的首选手术方式。临床上可通过提高术者的手术技能来降低手术时间,同时也可通过抗生素的合理使用、无创伤线皮内缝合切口以减少住院日,降低住院费用。对保守性手术者,术后监测血清β-hCG,必要时辅以MTX等药物,预防持续性异位妊娠的发生。更多还原

【Abstract】 【Objective】 To evaluate the far and late effects of operative laparoscopy vs laparotomy on ectopicpregnancy (EP),compare the virtue or defect,discuss repeated EP and persistent EP et al.【Methods】309 cases ofoperative EP were retrospectively analysed in First Hospital of Peking University from January 2001 to December2003,including 200 cases of laparoscopy and 109 laparotomy,compared the operation time,blood loss,transfusion,time of anus exsufflation,post-operation analgesia and antibiotics,hospital resources,the sexual,house work,and soon.【Results】There were no significance in operation time,hospital stay of the two groups (72.5±29.62 vs 75.48±29.02,8.68±3.48 vs 8.05±2.14,P >0.05),but in the blood loss,transfusion,exsufflation,analgesia,antibiotics,hospi-tal resource,after operation work and life,the laparoscopy group was obviously better than laparotomy (P <0.001).Because of the charge policy,laparoscopy EP hospital resource was much more higher than laparotomy (7606.15±1354.58 vs 6310.14±1917.19,P <0.05),but the virtue of laparoscopy for EP was confirmed by the patients in otheraspects,and becoming the first choice.【Conclusions】Operative laparoscopy for EP has more benefits than laparo-tomy,eg. high curative rate,small wound and scarless,little pain and beauty,quick recovery,etc. It has becomingthe routine and first choice in big cities in China,especially for young women who wanted baby in future. The tech-nique is safe and effective when performed by an experienced laparoscopist,so make more progress in the skill,low-er the antibiotics,use absorbable sutures in order to decrease the hospital stay and resource. Serum β-hCG assay isvery important after salpingostomy for preventive persistent EP,MTX is the best drug for the following treatment.更多还原