Application of laparoscopy in diagnosis and treatment of ectopic pregnancy
Ectopic pregnancy includes tubal pregnancy, abdominal pregnancy, ovarian pregnancy, cervical pregnancy and residual horn uterine pregnancy, of which tubal pregnancy accounts for 95% to 98%. In recent years, its incidence has been increasing year by year, and it is the leading cause of death among pregnant women during early pregnancy. The advent of laparoscopy has written a new chapter for the early diagnosis and treatment of ectopic pregnancy.
The significance of laparoscopy in the early diagnosis of ectopic pregnancy
If an ectopic pregnancy ruptures, the symptoms are typical, and the diagnosis is not difficult. Early diagnosis can not only make it possible to choose appropriate treatment methods such as preservation of fallopian tubes, but also greatly reduce the morbidity and mortality caused by diseases and treatments. The methods for early diagnosis of ectopic pregnancy include: vaginal ultrasound, blood β-hCG measurement, blood progesterone measurement, and diagnostic curettage and other methods. Among them, the application of vaginal ultrasound is the most valuable. For doctors with ultrasound diagnosis experience, the sensitivity of diagnosis can reach 70% to 87%, and the specificity can reach 85%. However, the false positive rate can reach 9%, and the false negative rate can reach 13%. Therefore, ultrasound diagnosis has certain limitations.
Laparoscopy should be performed in the following cases:
①If the blood β-hCG is greater than 2000IU/L, the intrauterine fetal sac is not found by ultrasound;
②Patients whose blood β-hCG is less than 2000IU L, and there is no villi at diagnosis and curettage, but the blood β-hCG does not decrease or continues to increase after diagnosis and curettage. Through laparoscopy, not only can confirm the diagnosis, avoid delaying the disease, but also can carry out surgical treatment.
Significance of laparoscopic surgery in the treatment of ectopic pregnancy
Laparoscopic surgery is more and more popular in clinical gynecology because of its good surgical results, less pain for patients, and quicker recovery after surgery. It should be emphasized that if there are laparoscopic facilities and techniques, laparoscopy is the preferred surgical method for ectopic pregnancy. It is generally believed that laparoscopic surgery is only suitable for cases where the fallopian tube is not ruptured or the fallopian tube has been ruptured but the hemodynamics is still stable. The reason is that the special position of the laparoscopic and the pneumoperitoneum can cause an increase in the burden on the breathing and circulatory system, such as hypoemia. Volume shock will increase the risk of anesthesia and surgery, so there are concerns about laparoscopic surgery. However, for experienced laparoscopy doctors, if there are appropriate anesthesia and advanced ECG monitoring measures and necessary supportive treatments such as blood transfusion, even if there is internal bleeding in ectopic pregnancy, hemodynamics have changed, you can still choose the abdominal cavity Mirror surgery. Of course, open surgery can be changed when necessary, which will not cause additional burden to the patient.
