腹腔镜下输卵管妊娠保守性手术中应用可吸收结扎夹止血与注射垂体后叶素止血的疗效比较
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摘要
目的:对比腹腔镜下输卵管妊娠保守性手术中应用可吸收结扎夹止血与注射垂体后叶素止血的疗效。方法:选取2017年1-12月期间本院收治的腹腔镜下输卵管妊娠保守性手术患者60例作为研究对象,采用随机数字表法将其分为对照组和观察组,对照组24例给予患侧输卵管系膜注射垂体后叶素,观察组36例患侧输卵管病灶供血血管放置可吸收结扎夹,对比两组患者的术中出血量、手术时间等指标。结果:观察组患者手术时间、术中出血量均明显少于对照组,差异均有统计学意义(P<0.05)。观察组盆腔引流管放置率为2.78%(1/36)明显低于对照组的62.50%(15/24),差异有统计学意义(X~2=26.264,P<0.05);且观察组保留输卵管率为94.44%(34/36)明显高于对照组的83.33%(20/24),差异有统计学意义(X~2=3.843,P=0.048)。两组患者于术后2~3个月子宫输卵管造影,观察组输卵管通畅率为80.56%(29/36)明显高于对照组的54.17%(13/24),完全梗阻率为5.56%(2/36)明显低于对照组的20.83%(5/24),差异均有统计学意义(P<0.05)。结论:在腹腔镜下输卵管妊娠保守性手术中放置可吸收结扎夹止血效果确定,减少了术中出血量,节省了手术时间,避免因害怕输卵管病灶再出血而留置盆腔引流管,减轻了患者的痛苦,最大限度保留患侧输卵管的功能,有益于患者,且简单易行,安全可靠,是一种值得推广的方法。
Objective:To compare the treatment efficiency of hemostasis through absorbable ligating clip and pituitrin injection applied to laparoscopic conservative operation of tubal pregnancy.Method:60 patients who needed laparoscopic conservative operation of tubal pregnancy in our hospital from January 2017 to December 2017 were selected and divided into control group and observation group by random digital table method.24 patients in the control group were treated with pituitrin injection on mesosalpinx on affected side,36 patients in the observation group were treated with absorbable ligating clip on the supplying blood vessel of oviduct nidus on affected side;indexes of intraoperative bleeding volume and time of operation of patients in two groups were compared.Result:The time of operation and intraoperative bleeding volume in the observation group were significantly less than those in the control group,the differences were statistically significant(P<0.05).The placement rate of pelvic drainage tube in the observation group was 2.78%(1/36),which was significantly lower than that in the control group 62.50%(15/24),the difference was statistically significant( X~2=26.264,P<0.05);and the retention rate of fallopian tube in the observation group was 94.44%(34/36),which was significantly higher than that in the control group 83.33%(20/24),the difference was statistically significant( X~2=3.843,P=0.048).The results of hysterosalpingography between 2 and 3 months after operation showed that the patency rate of fallopian tube in the observation group was 80.56%(29/36),which was significantly higher than 54.17%(13/24) in the control group,complete obstruction rate of observation group was 5.56%(2/36),which was apparently lower than 20.83%(5/24)of the control group,the differences were statistically significant(P<0.05).Conclusion:The hemostatic effect of placement of absorbable ligating clip in laparoscopic conservative operation of tubal pregnancy is confirmed:it can reduce intraoperative bleeding volume,shorten the time of operation,avoid retention of pelvic drainage tube for fear of rehaemorrhagia of oviduct nidus,lighten the pain of patients,retain the function of oviduct on affected side to the maximum,and contribute to patients.The operation procedure is simple,practicable,safe and reliable.Therefore,this method is worth of popularized and promoted.
Objective:To compare the treatment efficiency of hemostasis through absorbable ligating clip and pituitrin injection applied to laparoscopic conservative operation of tubal pregnancy.Method:60 patients who needed laparoscopic conservative operation of tubal pregnancy in our hospital from January 2017 to December 2017 were selected and divided into control group and observation group by random digital table method.24 patients in the control group were treated with pituitrin injection on mesosalpinx on affected side,36 patients in the observation group were treated with absorbable ligating clip on the supplying blood vessel of oviduct nidus on affected side;indexes of intraoperative bleeding volume and time of operation of patients in two groups were compared.Result:The time of operation and intraoperative bleeding volume in the observation group were significantly less than those in the control group,the differences were statistically significant(P<0.05).The placement rate of pelvic drainage tube in the observation group was 2.78%(1/36),which was significantly lower than that in the control group 62.50%(15/24),the difference was statistically significant( X~2=26.264,P<0.05);and the retention rate of fallopian tube in the observation group was 94.44%(34/36),which was significantly higher than that in the control group 83.33%(20/24),the difference was statistically significant( X~2=3.843,P=0.048).The results of hysterosalpingography between 2 and 3 months after operation showed that the patency rate of fallopian tube in the observation group was 80.56%(29/36),which was significantly higher than 54.17%(13/24) in the control group,complete obstruction rate of observation group was 5.56%(2/36),which was apparently lower than 20.83%(5/24)of the control group,the differences were statistically significant(P<0.05).Conclusion:The hemostatic effect of placement of absorbable ligating clip in laparoscopic conservative operation of tubal pregnancy is confirmed:it can reduce intraoperative bleeding volume,shorten the time of operation,avoid retention of pelvic drainage tube for fear of rehaemorrhagia of oviduct nidus,lighten the pain of patients,retain the function of oviduct on affected side to the maximum,and contribute to patients.The operation procedure is simple,practicable,safe and reliable.Therefore,this method is worth of popularized and promoted.
引文
[1]王燕兰,何青,游建冰.输卵管妊娠腹腔镜保守性手术中应用多点注射垂体后叶素联合MTX临床观察[J].中国地方病防治杂志,2014,7(s1):189-190.
[2]李宗婷,周哲.两点注射垂体后叶素在腹腔镜下输卵管妊娠保守性手术中的应用[J].江苏医药,2013,39(20):2457-2458.
[3]王燕兰.输卵管妊娠腹腔镜保守性手术中应用多点注射垂体后叶素联合MTX临床研究[J].齐齐哈尔医学院学报,2016,37(9):1177-1178.
[4]寇金玲.腹腔镜下输卵管妊娠保守性手术联合药物预防持续性异位妊娠的临床研究[J].中国医学创新,2010,7(25):94-95.
[5]范素鸿,夏利花.两种保守性手术方法治疗输卵管妊娠的效果分析[J].中国计划生育学杂志,2013,21(2):105-108.
[6]周振苇,何志龙.垂体后叶素在腹腔镜下输卵管妊娠保守手术中的止血效果观察[J].微创医学,2013,8(3):311-313.
[7]许翠娇,莫小余.化瘀止血汤、多点预注射垂体后叶素联合MTX对腹腔镜输卵管妊娠保守性手术出血的影响[J].内蒙古中医药,2017,36(9):58-59.
[8]杨红杰,林秋玲,周雪勤,等.系膜内注射垂体后叶素在腹腔镜输卵管妊娠保守手术中的应用[J].腹腔镜外科杂志,2013,8(11):825-827.
[9]卢美英,李明岐,王新蕾.腹腔镜输卵管妊娠保守性手术50例临床分析[J].中国医学创新,2012,9(21):140-141.
[10]龙正蓬,覃丽华.腹腔镜下保守性手术联合甲氨蝶呤防治输卵管妊娠后持续性异位妊娠的效果观察[J].中国临床新医学,2013,6(1):49-50.
[11]谭慧珍,张燕,何浏铭,等.腹腔镜输卵管妊娠切开取胚保守性手术中垂体后叶素的应用[J].中国医药导报,2013,10(3):69-71.
[12]陈义波.三种处理方式在预防腹腔镜输卵管妊娠保守性手术后持续性异位妊娠中的效果探讨[J].中国现代医学杂志,2014,24(3):71-73.
[13]唐卉.腹腔镜下输卵管妊娠保守手术处理方式对持续性异位妊娠预防效果的观察[J].中国计划生育学杂志,2016,24(7):482-485.
[14]陈益珊,陈少虹,赖文妹.输卵管妊娠腹腔镜下保守性手术后持续性异位妊娠19例临床分析[J].海南医学,2016,27(4):639-640.
[15]宋菁华,王克芳,张军,等.腹腔镜输卵管妊娠保守性手术后发生持续性异位妊娠的多因素分析[J].中国微创外科杂志,2016,16(8):677-680.
[16]邵会敏,彭宇,王彩芳,等.输卵管妊娠腹腔镜保守手术改良方案临床分析[J].临床医学,2013,33(11):83-84.
[17]王利想.输卵管妊娠腹腔镜保守手术改良方案的临床分析[J].医学理论与实践,2017,30(5):723-725.
[18]沈翠干.可吸收止血纱贴敷治疗Little区溃疡86例临床体会[J].中国医学创新,2009,6(15):172.
[19]曾小燕.腹腔镜下输卵管妊娠保守性手术的临床观察[J].微创医学,2014,9(6):794-795.
[20]唐蔚,唐春莲.腹腔镜下保守性手术治疗输卵管妊娠108例临床观察[J].现代诊断与治疗,2012,23(6):651-653.
[2]李宗婷,周哲.两点注射垂体后叶素在腹腔镜下输卵管妊娠保守性手术中的应用[J].江苏医药,2013,39(20):2457-2458.
[3]王燕兰.输卵管妊娠腹腔镜保守性手术中应用多点注射垂体后叶素联合MTX临床研究[J].齐齐哈尔医学院学报,2016,37(9):1177-1178.
[4]寇金玲.腹腔镜下输卵管妊娠保守性手术联合药物预防持续性异位妊娠的临床研究[J].中国医学创新,2010,7(25):94-95.
[5]范素鸿,夏利花.两种保守性手术方法治疗输卵管妊娠的效果分析[J].中国计划生育学杂志,2013,21(2):105-108.
[6]周振苇,何志龙.垂体后叶素在腹腔镜下输卵管妊娠保守手术中的止血效果观察[J].微创医学,2013,8(3):311-313.
[7]许翠娇,莫小余.化瘀止血汤、多点预注射垂体后叶素联合MTX对腹腔镜输卵管妊娠保守性手术出血的影响[J].内蒙古中医药,2017,36(9):58-59.
[8]杨红杰,林秋玲,周雪勤,等.系膜内注射垂体后叶素在腹腔镜输卵管妊娠保守手术中的应用[J].腹腔镜外科杂志,2013,8(11):825-827.
[9]卢美英,李明岐,王新蕾.腹腔镜输卵管妊娠保守性手术50例临床分析[J].中国医学创新,2012,9(21):140-141.
[10]龙正蓬,覃丽华.腹腔镜下保守性手术联合甲氨蝶呤防治输卵管妊娠后持续性异位妊娠的效果观察[J].中国临床新医学,2013,6(1):49-50.
[11]谭慧珍,张燕,何浏铭,等.腹腔镜输卵管妊娠切开取胚保守性手术中垂体后叶素的应用[J].中国医药导报,2013,10(3):69-71.
[12]陈义波.三种处理方式在预防腹腔镜输卵管妊娠保守性手术后持续性异位妊娠中的效果探讨[J].中国现代医学杂志,2014,24(3):71-73.
[13]唐卉.腹腔镜下输卵管妊娠保守手术处理方式对持续性异位妊娠预防效果的观察[J].中国计划生育学杂志,2016,24(7):482-485.
[14]陈益珊,陈少虹,赖文妹.输卵管妊娠腹腔镜下保守性手术后持续性异位妊娠19例临床分析[J].海南医学,2016,27(4):639-640.
[15]宋菁华,王克芳,张军,等.腹腔镜输卵管妊娠保守性手术后发生持续性异位妊娠的多因素分析[J].中国微创外科杂志,2016,16(8):677-680.
[16]邵会敏,彭宇,王彩芳,等.输卵管妊娠腹腔镜保守手术改良方案临床分析[J].临床医学,2013,33(11):83-84.
[17]王利想.输卵管妊娠腹腔镜保守手术改良方案的临床分析[J].医学理论与实践,2017,30(5):723-725.
[18]沈翠干.可吸收止血纱贴敷治疗Little区溃疡86例临床体会[J].中国医学创新,2009,6(15):172.
[19]曾小燕.腹腔镜下输卵管妊娠保守性手术的临床观察[J].微创医学,2014,9(6):794-795.
[20]唐蔚,唐春莲.腹腔镜下保守性手术治疗输卵管妊娠108例临床观察[J].现代诊断与治疗,2012,23(6):651-653.