腹腔镜手术治疗妊娠期附件包块18例分析
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摘要
目的探讨对有生育要求的妊娠期附件包块患者行腹腔镜手术治疗的可行性和安全性。方法分析2011年3月~2017年10月对18例妊娠期附件包块患者采用腹腔镜手术治疗的围手术期资料及妊娠结局。结果 18例患者行腹腔镜手术均操作成功,无1例中转开腹及发生围手术期严重并发症。3例行腹腔镜下患侧附件切除术,2例因为卵巢囊肿蒂扭转坏死,1例因为术中冰冻提示卵巢交界性肿瘤;15例行腹腔镜卵巢肿瘤剥除术,其中4例术时卵巢肿瘤蒂扭转复位后恢复血供行囊肿剥除术,17例术后病理证实为良性卵巢肿瘤,1例为交界性卵巢肿瘤。手术时间(81.6±53.1)分钟,术中出血(37.3±63.5)毫升,术后排气时间(9.8±4.7)小时,术后住院(3.6±1.0)天。术后1例患者2周后放弃妊娠,1例继续围产期保健,2例回老家生产失访,其余14例均已分娩,新生儿出生后Apgar评分均为10分,出生体重2500~3950g。结论对妊娠期附件包块患者行腹腔镜手术治疗是安全可行的,对妊娠结局无不良影响。
Objective To investigate the feasibility and safety of laparoscopic surgery for patients with pregnancy-related accessory mass with reproductive requirements. Methods From March 2011 to October 2017, the data of perioperative period and pregnancy outcome of 18 cases of pregnancy complicated with adnexal mass treated by laparoscopic surgery were analyzed. Results All of the 18 patients underwent laparoscopic surgery successfully. None of them underwent laparotomy and severe perioperative complications occurred. Three cases of laparoscopic ipsilateral appendiceal resection, two cases of ovarian cyst torsion and necrosis, one case because of intraoperative ovarian borderline ovarian cancer; 15 cases of laparoscopic ovarian tumor stripping, of which 4 cases of ovarian Tumor pedicle torsion reduction after the restoration of blood supply cyst stripping, 17 cases of pathologically confirmed benign ovarian tumors, 1 case of borderline ovarian tumors. The operation time(81.6 ± 53.1) minutes, intraoperative bleeding(37.3 ± 63.5) ml, postoperative exhaust time(9.8 ± 4.7) hours and postoperative hospital stay(3.6 ± 1.0) days. After 1 week, one patient gave up the pregnancy after 2 weeks. One patient continued perinatal care and two returned to the home. The other 14 patients were delivered. The Apgar score was 10 and the birth weight was 2500-3950 g after birth. Conclusion Laparoscopic surgery is safe and feasible for patients with adnexal mass during pregnancy, and has no adverse effect on pregnancy outcome.
Objective To investigate the feasibility and safety of laparoscopic surgery for patients with pregnancy-related accessory mass with reproductive requirements. Methods From March 2011 to October 2017, the data of perioperative period and pregnancy outcome of 18 cases of pregnancy complicated with adnexal mass treated by laparoscopic surgery were analyzed. Results All of the 18 patients underwent laparoscopic surgery successfully. None of them underwent laparotomy and severe perioperative complications occurred. Three cases of laparoscopic ipsilateral appendiceal resection, two cases of ovarian cyst torsion and necrosis, one case because of intraoperative ovarian borderline ovarian cancer; 15 cases of laparoscopic ovarian tumor stripping, of which 4 cases of ovarian Tumor pedicle torsion reduction after the restoration of blood supply cyst stripping, 17 cases of pathologically confirmed benign ovarian tumors, 1 case of borderline ovarian tumors. The operation time(81.6 ± 53.1) minutes, intraoperative bleeding(37.3 ± 63.5) ml, postoperative exhaust time(9.8 ± 4.7) hours and postoperative hospital stay(3.6 ± 1.0) days. After 1 week, one patient gave up the pregnancy after 2 weeks. One patient continued perinatal care and two returned to the home. The other 14 patients were delivered. The Apgar score was 10 and the birth weight was 2500-3950 g after birth. Conclusion Laparoscopic surgery is safe and feasible for patients with adnexal mass during pregnancy, and has no adverse effect on pregnancy outcome.
引文
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[4]蔡慧华.腹腔镜手术治疗妊娠期卵巢良性肿瘤16例临床分析[J].中国内镜杂志,2015,21(1):65-68.
[5]马聪,徐礼江,何逾祥,等.腹腔镜手术治疗妊娠期卵巢良性肿瘤有效性和安全性分析[J].中国实用妇科与产科杂志,2013,29(8):638-641.
[6]Rizzo AG.Laparoscopic surgery in pregnancy:Long-term followup.Laparoendosc Adv Surg Tech A,2003,13:11-15.
[2]Morice P,Uzanc,Couy S,etal.Gynaecological cancers in preganancy.Lancet,2012,379:558-569.
[3]JONATHANPEARL,RAYMONDPRICE.William Richardson.Guidelines for diagnosis,treatment,and use of laparoscopy forsurgical problems during pregnancy[J].Surg Endosc,2011,25(11):3479-3492.
[4]蔡慧华.腹腔镜手术治疗妊娠期卵巢良性肿瘤16例临床分析[J].中国内镜杂志,2015,21(1):65-68.
[5]马聪,徐礼江,何逾祥,等.腹腔镜手术治疗妊娠期卵巢良性肿瘤有效性和安全性分析[J].中国实用妇科与产科杂志,2013,29(8):638-641.
[6]Rizzo AG.Laparoscopic surgery in pregnancy:Long-term followup.Laparoendosc Adv Surg Tech A,2003,13:11-15.