Clinical Comparative Analysis Of Laparoscopic Surgery And Laparotomy Treatment Tubal Interstitial Pregnancy

Background：Tubal interstitial pregnancy is a fertilized egg planted in tubal part of the musclewall of the uterus, the position in the uterine horn, belong to the scope of ectopicpregnancy. Its low incidence, for domestic reports its only4.2%of the same period inectopic pregnancy; Abroad reported that the incidence rate is2-4%. Cause interstitialtubal surrounding myometrium thick. It can maintain pregnancy to3-5months beforerupture. For interstitial rich blood supply, once broken, can cause bleeding andlife-threatening, the mortality rate of about2.5%. The traditional surgical treatment arefocal resection or dissection. Including tubal incision embryo surgery, cornualresection and ipsilateral tubal resection, etc. Early diagnosis method for the vaginalultrasound combined with the high sensitivity of the β-hCG measurement. Tubalinterstitial pregnancy had contraindications for laparoscopic surgery. The recent20years, laparoscopic surgery treatment tubal interstitial pregnancy is gradualdevelopment.Objective:In the surgical treatment of tubal interstitial pregnancy, laparoscopic ipsilateralsalpingectomy is feasible? compared with laparotomy if the laparoscopic surgery hasadvantage?Method:Collected Dalian Maternity Hospital32patients’ medical records because tubalinterstitial pregnancy of ipsilateral salpingectomy from March2006to March2012.There were10patients underwent laparotomy;22patients underwent laparoscopicsurgery.Laparoscopic surgery without transfer laparotomy. Inclusion criteria: patientswho had ipsilateral salpingectomy on the affected side. Exclusion criteria:1.patients who had taking embryo by uterine tube pregnancy incision on the affected side，tubalembryo suction surgery using the uteroscope and the laparoscope coordination treatsand uterine horn resection and total hysterectomy on the affected side;2.patients whowere only given conservative treatment, and not given the surgical treatment;3.patientswith bilateral interstitial pregnancy;4.patients with conversion into laparotomy duringlaparoscopic surgery.32patients underwent preoperative examination or intraoperativeexploration was diagnosed with tubal interstitial pregnancy and Pathologicalpreoperative or intraoperative diagnosis consistent. Persistent ectopic pregnancy isdefined as: After ectopic pregnancy the recurrence of abdominal hemorrhage orpostoperative blood β-hCG remains elevated, do not drop or every72h decline <20%.Results:Case characteristics of the laparoscopic surgery group and laparotomy group in age,menopause, pregnancies, parity, history of abdominal surgery, vaginal bleeding,abdominal pain，IVF postoperative，the history of ectopic pregnancy terms of P valueswere greater than0.05, were not statistically different; Preoperative contrast in the massposition, mass maximum diameter, mass rupture, preoperative curettage, preoperativemethotrexate treatment, preoperative hemoglobin value and preoperative blood β-hCGvalue terms of P values greater than0.05, were not statistically different; Surgery resultsin operative time, postoperative hemoglobin value, after3days of serum β-hCG value,the persistent postoperative ectopic pregnancy P value were greater than0.05, were notstatistically different; Intraoperative blood transfusion, intraoperative intestinal injury,intraoperative vascular injury, Postoperative fever, postoperative urinary retention,incision healed bad aspects, both groups did not happen. Intraoperative blood loss,postoperative exhaust time, hospitalization time, respectively (54.8±31.0) and (367.0±293.6) ml, P <0.05;(1.1±0.4) and (2.2±0.4) d, P<0.05;(5.7±1.2) and (8.8±3.4) d, P<0.01, there was significant difference between the two groups.Conclusion:1. For patients with tubal interstitial pregnancy ipsilateral salpingectomy, this studycompared with laparotomy, in intraoperative blood loss, postoperative exhaust time,hospitalization time, laparoscopic surgery has potential advantages.2. For patients with tubal interstitial pregnancy ipsilateral salpingectomy, this studycompared with laparotomy, laparoscopic surgery has the feasibility, safety andpracticality.