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目的评估妊娠期腹腔镜附件手术的安全性、妊娠结局及新生儿的近期情况。方法回顾2004年3月至2015年5月于北京大学第一医院行妊娠期附件手术43例患者的临床资料,其中33例接受腹腔镜手术、10例接受开腹手术。分析两种术式的围手术期相关情况、随访妊娠结局及新生儿出生情况。结果腹腔镜组平均年龄(28.18±4.02)岁,平均孕周(17.12±5.09)周,初产妇占93.94%(31/33),体重指数(BMI)平均值为(23.09±3.79),平均肿瘤大小为(8.26±2.91)cm。开腹组平均年龄(26.40±4.09)岁,平均孕周(20.60±7.56)周,初产妇占100.00%(10/10),体重指数(BMI)平均值为(23.04±3.47),平均肿瘤大小为(8.63±3.67)cm。两组的年龄、孕周、初产妇所占比例、BMI、肿瘤大小差异无统计学意义(P>0.05)。两组采用的手术类型差异无统计学意义(P>0.05)。腹腔镜组的平均手术时间为(71.45±27.64)min,平均术中出血为(18.27±30.50)ml,平均术后排气时间为(1.39±0.65)d,宫缩抑制剂使用率为39.39%(13/33)。开腹组的平均手术时间为(66.40±33.07)min,平均术中出血为(38.00±26.16)ml,平均术后排气时间为(2.00±0.67)d,宫缩抑制剂使用率90.00%(9/10)。两组患者术后恢复好,均无手术相关感染、损伤、流产及早产发生。腹腔镜组术中出血、术后排气时间及宫缩抑制剂使用率明显低于开腹组(P<0.01),腹腔镜组的手术时间与开腹组无明显差别(P>0.05)。腹腔镜组有随访结局的26例患者中,阴道分娩15例(57.69%),剖宫产11例(42.31%);3例(11.54%)发生早产;新生儿Apgar评分1min、5min均为10分;无新生儿畸形。结论妊娠期腹腔镜附件手术多在中孕期实施,该手术出血少、术后排气快,未发现手术相关的新生儿畸形,由有经验的医生施术,该项技术较为安全。妊娠期腹腔镜附件手术对患者的产科和新生儿结局无明显影响。
Objective To assess the safety of laparoscopic surgery during pregnancy, the outcome of pregnancy and the recent status of newborns. Methods From March 2004 to May 2015, the clinical data of 43 cases of pregnancy-related accessory surgery in Peking University First Hospital were reviewed. Among them, 33 cases underwent laparoscopic surgery and 10 underwent laparotomy. Analyze the perioperative status of the two surgical procedures, follow-up of pregnancy outcome and neonatal birth. Results The average age of the laparoscopic group (28.18 ± 4.02) years, the average gestational age (17.12 ± 5.09) weeks, the primiparas accounted for 93.94% (31/33) and the average body mass index (BMI) was (23.09 ± 3.79) The size is (8.26 ± 2.91) cm. The average age of the open group (26.40 ± 4.09) years, the average gestational age (20.60 ± 7.56) weeks, primipara 100.00% (10/10), body mass index (BMI) mean (23.04 ± 3.47), the average tumor size (8.63 ± 3.67) cm. The age, gestational age, proportion of primipara, BMI and tumor size in the two groups had no significant difference (P> 0.05). There was no significant difference in the type of surgery between the two groups (P> 0.05). The average operation time of laparoscopic group was (71.45 ± 27.64) min, the average intraoperative bleeding was (18.27 ± 30.50) ml, the average postoperative exhaust time was (1.39 ± 0.65) d, the usage of tocolytic agent was 39.39% (13/33). The mean operation time was (66.40 ± 33.07) min in open group, and the average intraoperative bleeding was (38.00 ± 26.16) ml. The average postoperative exhaust time was (2.00 ± 0.67) d and the tocolytic use rate was 90.00% 9/10). Two groups of patients recovered well, no surgery-related infections, injuries, abortion and premature birth. Laparoscopic surgery bleeding, postoperative exhaust time and uterine contractility inhibitor use rate was significantly lower than the open group (P <0.01), laparoscopic operation time and laparotomy group no significant difference (P> 0.05). Among 26 patients who had follow-up results in laparoscopic group, 15 cases (57.69%) were vaginal delivery and 11 cases (42.31%) were cesarean section; 3 cases (11.54%) were premature; Apgar score was 10 Points; no newborn deformity. Conclusions Pregnancy laparoscopic accessory surgery is mostly performed during the second trimester. This procedure has less bleeding, faster exhaust after operation, and no surgery-related neonatal malformations. Surgery is performed by an experienced doctor and the technique is relatively safe. Laparoscopic surgery during pregnancy had no significant effect on obstetric and neonatal outcomes in patients.