标题：腹腔镜手术治疗妊娠合并卵巢良性肿瘤的疗效及对妊娠结局的影响

      作者：任彦洁，吕小慧，刘朵朵    空军军医大学第一附属医院妇产科，陕西 西安 710032

      卷次： 2020年31卷16期

      【摘要】 目的 探讨腹腔镜手术治疗妊娠合并卵巢良性肿瘤的临床疗效及妊娠结局。方法 选取空军军医大学第一附属医院妇产科2016年1月至2019年1月收治的妊娠合并卵巢良性肿瘤患者90例，按照随机数表法将患者分为观察组和对照组，每组45例。观察组给予腹腔镜手术治疗，对照组给予常规开腹手术治疗。比较两组患者的手术时间、术中出血量、术后排气时间、术后下床时间、住院时间等临床指标；比较两组患者的妊娠结局、术后并发症及娩出婴儿盖泽尔评分；比较两组患者治疗前后的雌二醇(E2)、促卵泡生成素(FSH)、促黄体生成素(LH)水平。结果 观察组和对照组患者术中出血量[(28.84±3.27) mL vs (84.39±8.28) mL]、手术时间[(52.74±4.58) min vs (73.47±8.29) min]、术后排气时间[(17.38±2.73) h vs (26.29±4.46) h]、术后下床活动时间[(20.53±4.28) h vs (31.28±5.64) h]及住院时间[(6.63±1.24) d vs (9.36±2.17) d]比较，观察组明显少于或短于对照组，差异均有统计学意义(P<0.05)；观察组患者的VAS评分为(2.35±0.56)分，明显低于对照组的(3.62±0.88)分，差异有统计学意义(P<0.05)；观察组和对照组患者治疗后的 E2 [(262.64±22.74) pmol/L vs (185.28±17.29) pmol/L]、FSH [(4.57±0.84)U/L vs (2.96±0.56) U/L]、LH[(1.27±0.31) U/L vs (0.85±0.23) U/L]水平比较，观察组明显高于对照组，差异均有统计学意义(P<0.05)；观察组患者顺产率为84.44%，明显高于对照组的44.44%，早产率、剖宫产率和新生儿窒息率分别为2.22%、8.89%、4.44%，均明显低于对照组的13.33%、24.44%、17.78%，差异均有统计学意义(P<0.05)；观察组患者的并发症发生率为4.44%，明显低于对照组的17.78%，差异有统计学意义(P<0.05)。结论 腹腔镜手术治疗妊娠合并卵巢良性肿瘤可减少手术创伤，促进患者术后恢复，且对妊娠结局影响较小，安全性高，值得临床推广应用。
      【关键词】 腹腔镜手术；常规开腹手术；妊娠；卵巢良性肿瘤；妊娠结局
      【中图分类号】 R737.31 【文献标识码】 A 【文章编号】 1003—6350（2020）16—2071—04

Clinical efficacy of laparoscopic surgery in the treatment of pregnancy with ovarian benign tumor and its effecton pregnancy outcome.
REN Yan-jie, LV Xiao-hui, LIU Duo-duo. Department of Gynaecology and Obstetrics, the FirstAffiliated Hospital of Air Force Medical University, Xi'an 710032, Shaanxi, CHINA
【Abstract】 Objective To investigate the clinical efficacy of laparoscopic surgery in the treatment of pregnancywith ovarian benign tumor and its effect on pregnancy outcome. Methods Ninety pregnant women with ovarian benigntumor admitted to the First Affiliated Hospital of Air Force Military Medical University from January 2016 to January2019 were selected. All the patients were divided into observation group and control group according to the random num-ber table method, with 45 patients in each group. The observation group was given laparoscopic surgery, and the controlgroup was given conventional laparotomy. The operation time, intraoperative bleeding volume, postoperative exhausttime, off-bed activity time after operation, and length of hospital stay were compared between the two groups. The preg-nancy outcome, postoperative complications, and Gaizel score of the baby were compared between the two groups. Thelevels of estradiol (E2), follicle stimulating hormone (FSH), and luteinizing hormone (LH) before and after treatmentwere compared between the two groups. Results The observation group was significantly less than or shorter than thecontrol group in the following indexes (P<0.05): intraoperative blood loss, (28.84±3.27) mL vs (84.39±8.28) mL; opera-tion time, (52.74±4.58) min vs (73.47±8.29) min; postoperative exhaust time, (17.38±2.73) h vs (26.29±4.46) h; off-bedactivity time after operation, (20.53±4.28) h vs (31.28±5.64) h; length of hospital stay, (6.63±1.24) d vs (9.36±2.17) d. TheVAS score of the observation group was (2.35±0.56) points, which was significantly lower than (3.62±0.88) points of thecontrol group (P<0.05). The observation group was significantly higher than the control group in E2, FSH, LH (P<0.05):E2, (262.64±22.74) pmol/L vs (185.28±17.29) pmol/L; FSH, (4.57±0.84) U/L vs (2.96±0.56) U/L; LH, (1.27±0.31) U/L vs(0.85±0.23) U/L. The normal labor rate of observation group was 84.44%, which was significantly higher than 44.44%of control group, and the premature birth rate, cesarean section rate, and neonatal asphyxia rate were 2.22%, 8.89%, and4.44%, which were significantly lower than 13.33%, 24.44%, 17.78% in the control group (P<0.05). The incidence ofcomplications in the observation group was 4.44%, which was significantly lower than 17.78% in the control group (P<0.05). Conclusion Laparoscopic surgery for pregnancy with ovarian benign tumors can reduce surgical trauma and pro-mote postoperative recovery, and has little effect on pregnancy outcomes and high safety, which is worthy of clinical pro-motion.
      【Key words】 Laparo