Discussion On Diagnosis And Treatments Of Interstitial Tubal Pregnancy: Clinical Analysis Of60Cases

Objective: in this paper, throughing the analysis and follow-up review ofthe diagnosis and treatment of60cases of interstitial tubal pregnancy patients,to research interstitial tubal pregnancy clinical manifestation, auxiliaryexamination, treatment. Comparing the clinical efficacy of laparoscopicoperation and open operation. Following-up prognosis of the patients,summarizing the influence of treatment outcome of different clinical treatmentmethods. Exploring the operation method which can injury little of thefertility.Method: colleting60patients of interstitial tubal pregnancy whoadmission to the second hospital of Hebei Medical University from2002January to2012May and also accepted treatments. Analyzed retrospectivelyof the clinical data of interstitial tubal pregnancy, including: age, time ofmenopause, vaginal bleeding and abdominal pain; menstrual history ofmarriage, the times of artificial abortion; ultrasound results, the HCG change,MTX applications; operation method, size of the gestational sac, bloodaccumulates in the pelvic cavity, volume of bleeding, blood transfusion,postoperative hospitalization time; persistent ectopic pregnancy after operation,postoperative follow-up etc..Results: The number of patients with a total of60patients, aged22-45years, mean32.7±6.1years; all the patients had the history of menopause,menopause time was29-120days, with an average of56.9±19.5days;34patients with vaginal bleeding, bleeding time was1-45days, with an averageof14.2±13.8days;44cases with abdominal pain, the abdominal pain timewas1-45days, the average time was5.8±10.3days; at the same time withabdominal pain and vaginal bleeding in25cases; shock on admission in10patients;10patients were first pregnancy, the maternal were41cases, including16cases of cesarean section;31cases of artificial abortion patients,with an average of1.2±1.0times;3cases had a history of medicineabortion;5cases of patients with a history of other uterine cavity operation.3patients had had abortion outside the hospital before the admmision. In60patients:21cases of laparoscopic operation,37cases of open operation,laparoscopic conversion to open operation in1cases, interstitial pregnancydrug injection with B ultrasound monitoring in1cases.21cases oflaparoscopic operation were successfully completed, without thecomplications of persistent ectopic pregnancy after operation. The open groupoperation mode is divided into:①cornual wedge resection (11cases,19%);②cornual wedge resection+salpingectomy (8cases,13.8%);③interstitialtubal pregnancy lesions incision and embryo-taking surgery (retention orremoval of tubal)(19cases,32.7%);④Interstitial tubal pregnancy rupturerepair (3cases,5.2%). Laparoscopic operation mode is divided into:①laparoscopic cornual wedge resection+salpingectomy (5cases,8.6%);②laparoscopic interstitial tubal pregnancy lesions incision and embryo-takingsurgery+ipsilateral tubal ligation (3cases,5.2%);③laparoscopicinterstitial portion incision and embryo-taking surgery (retention or removalof tubal)(9cases,15.5%). Operation time:45-106min, intraoperativebleeding volume:10-1000ml, hospitalization time after operation:4-24days.1case of laparoscopic operation had sustained Ectopic pregnancypostoperative. Postoperative follow-up results: follow-up of25people,35were lost to follow.25cases of8patients were followed up for1+months to3years after operation in patients with pregnancy,1patients had artificialabortion pregnancy1+months after operation,1patient after1+years becauseof left fallopian tube pregnancy affected side salpingectomy,5cases hadcesarean section in36-38weeks of pregnancy,1case had two times offull-term normal delivery after2year and4years of postoperative.Conclusions: Laparoscopic operation is little trauma, safety andeffectiveness, and it most appropriate for the stable hemodynamics interstitialpregnancy. For mass rupture, shock of intraabdominal bleeding in emergency patients or when the hospital does not have the laparoscopy operationphysicians or lack of operation experience of laparoscopic treatment ofinterstitial pregnancy, open operation is still the best treatment for tubalpregnancy.