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目的研究异位妊娠伴有失血性休克患者行腹腔镜手术的临床效果。方法1997年1月至2005年6月在沈阳市第五人民医院采用腹腔镜治疗输卵管异位妊娠174例,其中44例异位妊娠伴有失血性休克为休克组,其余130例为无休克组。入院后在有效纠正休克的同时,在全麻下行腹腔镜手术,根据病变情况及患者是否要求保留生育功能分别采取输卵管切除术或开窗术。结果休克组术前腹腔内出血量均大于1000mL,最高达2600mL。术中发现,伴出血性休克的异位妊娠中,异位妊娠部位仅2例在输卵管间质部,6例在峡部,36例在壶腹部。其中34例行输卵管切除术,10例行开窗术。休克组术中出血量、手术时间以及术后住院时间与无休克组差异无显著性意义。两组患者均未发生与穿刺及气腹有关的并发症及术中与术后并发症。结论在有效抗休克的同时熟练地行腹腔镜手术操作,术中做好严密的监测,腹腔镜手术治疗异位妊娠伴失血性休克能够顺利完成,并且显示出良好的疗效。
Objective To study the clinical effect of laparoscopic surgery in patients with ectopic pregnancy and hemorrhagic shock. Methods From January 1997 to June 2005, 174 cases of tubal ectopic pregnancy were treated with laparoscopy in the Fifth People’s Hospital of Shenyang City. 44 cases of ectopic pregnancy with hemorrhagic shock were in shock group and 130 cases in non-shock group . After admission to correct shock at the same time, laparoscopic surgery under general anesthesia, according to the lesion and whether the patient is required to retain reproductive function, respectively, to take tubal resection or fenestration. Results Preoperative intraperitoneal hemorrhage in the shock group was greater than 1000mL, up to 2600mL. Intraoperative findings, with hemorrhagic shock ectopic pregnancy, ectopic pregnancy site only 2 cases of tubal interstitial, 6 cases in the isthmus, 36 cases in the ampulla. Of them, 34 patients underwent tubal resection and 10 patients underwent window opening. There was no significant difference in bleeding volume, operation time, postoperative hospital stay and no shock in shock group. No complications related to puncture and pneumoperitoneum occurred in both groups and intraoperative and postoperative complications occurred. Conclusions Laparoscopic surgery is practiced well while anti-shock is effective, and strict monitoring during operation is needed. Laparoscopic surgery for ectopic pregnancy with hemorrhagic shock can be successfully completed and shows good curative effect.