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浅议黄体剥除预防持续性异位妊娠的临床问题 |
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p;observation group had one (2.27%) case of PEP and the control group had 2 (4.76%) cases,with no significant difference (χ2=0.395,P>0.05).The level of βhCG on the postoperative day 1 was decreased in both groups compared to that before operation (P<0.01),but no significant difference between the two groups (P>0.05); no difference was noted in the level of βhCG on the postoperative day 3 and 7 between the two groups (P>0.05); On day 12,it was markedly higher in the control group than that in the observation group(P<0.01).The control group observed more adverse events.Conclusion:The therapeutic efficacy of enucleation of corpus luteum equals to MTX with less adverse effect.
Key words persistent ectopic pregnancy enucleation of corpus luteum laparoscopic conservative operation methotrexate
随着异位妊娠的诊断技术的不断提高,异位妊娠保守性手术日益增多。腹腔镜手术作为治疗输卵管妊娠安全、有效的方法已被广泛接受[1],但也导致手术并发症即持续性异位妊娠(PEP)增多。如何及时预防及诊断持续性异位妊娠成为临床研究的重点。笔者采取腹腔镜手术加妊娠黄体剥除预防持续性异位妊娠,取得较好的疗效,现报道如下。
1 临床资料
2007年1月~2007年12月,我院对有生育要求的异位妊娠86例行腹腔镜保守性手术。年龄19~32岁,平均25.1岁。均依据病史、体征、血βhCG测定和盆腔或阴道B超检查确诊,并经术后病理检查证实。其中输卵管壶腹部妊娠57例,峡部妊娠20例,伞部妊娠8例,间质部妊娠1例。86例随机分为观察组44例,对照组42例。两组患者年龄、孕次、产次、阴道流血、包块大小均具可比性,见表1。
2 治疗方法
气管插管全身麻醉,于脐轮下缘作1cm的观察孔,左、右下腹麦氏点附近作0.5cm的操作孔,分别置钳、剪、电刀或超声刀等。明确病变部位和类型表1 两组患者基本情况比较后,决定保守性手术的方式。观察组清除胚胎后同时剥除黄体,对照组术中用MTX 20mg经0.9%氯化钠液2ml稀释后注入患侧输卵管近端残腔。
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