Objective To compare and analyze the impact on maternal-fetal of laparoscopy and abdominal laparotomy and evaluate the safety of laparoscopy during pregnancy.Methods In this prospective controlled study,20 pregnant patients underwent a laparoscopy,and the other 20 pregnant patients underwent an exploratory laparotomy during the same period of time.The parameters including anesthesia time,operative time,blood loss,arterial blood gas analysis in the fifteen minute after surgery,uterine artery blood flow,postoperative pain,postoperative recovery and pregnancy outcomes were collected.Results The anesthesia time and the operative time in laparoscopic group were significantly shorter than those in laparotomy group [(18.91 ± 8.76) min vs (35.28 ± 14.67) min,t=4.28,P ＜ 0.05,(17.85 ± 6.32) min vs (30.27 ± 10.41) min,t=4.56,P ＜ 0.05].The blood loss was significantly different during laparoscopic group and laparotomy group [(15.48 ± 10.24) ml vs (25.48 ± 15.56) ml,t=2.40,P ＜ 0.05].The stubbs catheter time,postoperative ambulation time,postoperative discharge time in the laparoscopic group were (6.58 ± 0.92) h,(6.98 ± 1.69) h and (18.52 ± 3.45) h respectively,while those were (24.63 ± 3.85) h,(25.37 ± 5.34) h,(23.67 ± 7.81) h in the laparotomy group (t=2.70,14.68,20.39; all P ＜ 0.05).The postoperative pain by laparoscopy was significantly lighter than that by laparotomy (P ＜ 0.05).There was no statistical significant difference between arterial blood gas analysis and uterine artery blood flow in two groups (P ＞ 0.05),and we didn't see any difference from abortion rate,premature birth rate,term delivery rate,the rate of birth defects,neonatal Apgar score and full-term birth weight.Conclusion Compared with laparotomy,laparoscopy has relatively less impact on maternal-fetal,and it won't increase the risk of adverse pregnancy outcomes.%目的 对比分析妊娠期腹腔镜与开腹手术对母胎影响的情况,评估妊娠期腹腔镜的安全性.方法 采用前瞻性对照研究方法,妊娠期腹腔镜手术与开腹手术病例各20例,将腹腔镜组、开腹组的麻醉时间、手术时间、出血量、术后15 min的动脉血气分析及子宫动脉血流参数、术后镇痛、术后恢复情况及妊娠结局进行对比研究.结果 妊娠期腹腔镜手术组麻醉时间较开腹组短[(18.91±8.76)min vs.(35.28±14.67)min;t=4.28,P＜0.05],手术时间较开腹组短[(17.85±6.32)min vs.(30.27±10.41)min;t=4.56,P＜0.05];腹腔镜组出血量较开腹组少[(15.48±10.24)mlvs.(25.48±15.56)ml;t=2.40,p＜0.05].腹腔镜手术组拔尿管时间、术后下床时间、术后排气时间分别为(6.58±0.92)h、(6.98±1.69)h、(18.52±3.45)h,较开腹组的(24.63±3.85)h、(25.37±5.34)h、(23.67±7.81)h短(t=2.70,14.68,20.39;P＜0.05).妊娠期腹腔镜术后疼痛较开腹手术明显轻(P＜0.05);腹腔镜组和开腹组术后15 min的动脉血气分析及子宫动脉血流参数比较差异无统计学意义(P＜0.05).腹腔镜组、开腹组和正常妊娠组的流产率、早产率、足月分娩率、出生缺陷率、新生儿Apgar评分、足月新生儿体重比较差异无统计学意义(P＞0.05).结论 妊娠期腹腔镜手术较开腹手术对母胎的影响小,妊娠期腹腔镜手术不增加妊娠不良结局的风险.
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