Clinical Diagnosis About Unruptured Tubal Ectopic Pregnancy Treated By Laparoscopic Conservative Surgery

Objective To evaluate the clinical efficiency and the rate of pregnancy in uterus of laparoscopic conservative Surgery in treatment of unruptured tubal pregnancy and the prevent of PEP.Methods A retrospectively analysis was carried out in 50 cases with unruptured ectopic pregnancy and treated by laparoscopic conservative surgery from January 2005 to September 2010 in our hospital. The patients who had amenorrhea, hypo gastric pain, irregular bleeding of vagina, positive uterine HCG, and B ultrasonic no gestational sac in uterus, which were diagnosed as ectopic pregnancy. They had balanced vital signs, and wanted to preserving fertility, which were operated with laparoscopic conservative surgery.The surgery modes were salpingotomy and salpingo-umbrella extrusion.Those were had mifepristone after surgery who did not been found gestational sac during the operation. These patients were operated hysterosalpingography three months later.Results All operations which were done by laparoscopic conservative surgery were succeeding, without complication, no case into abdominal operations; no case laparoscopic conservative surgery occurring persistent ectopic pregnancy. The rate of tubal patency was 55.6%.44 cases were operated by salpingotomy,6 cases were operated by salpingo-umbrella extrusion.41 cases were been found gestational sac during the operation. Average operation time was 55±7min,after operation average bleeding content was 40ml(15-195ml).; average breaking wind time was 25.3±4.5h; average preserving ureter time was 19.0±3.3h; average being in hospital time was 4.5±1.0d.45 cases that pathology report finding chorion tissue; 5 cases that pathology report not finding chorion tissue. After 3 months 27 cases were operated hysterosalpingography,15 cases tubal patency, the rate of tubal patency was 55.6%(15/27); 12 cases tubal unpatency, the rate of tubal unpatency was 44.4%(12/27).By September 2010,2 cases occurred pregnancy in uterus,3 cases occurred pre-ectopic pregnancy, during operation we found same side tubal, so these patients were operated with salpingectomy.Conclusions The patients with unruptured ectopic pregnancy treated by laparoscopic conservative surgery had short operation time; low operation damnification; and preserving tubal.The patients with unruptured ectopic pregnancy treated by laparoscopic conservative surgery were increased re-pregnancy chance, and after operation assisted treatment by mifepristone could avoid occurring persistent ectopic pregnancy, which could be used widely in clinical operations.9 cases which were not been found chorion tissue during operation had mifepristone, no case occurring persistent ectopic pregnancy.In order to preserve fertility, laparoscopic conservative surgery was a safe and feasible approach in treatment of tubal pregnancy. The important problem was the rate of tubal patency and the rate of pregnancy in uterus after operation. Preoperative serum HCG levels, size of tube gestational sac were significant factors influencing successful laparoscopic surgery. Laparoscopic salpingotomy may be practised as conservative surgery for proximal ectopic pregnancy, and gestational mass size is not as important and is not a relative contraindication for conservative laparoscopic surgery, as previously reported. Low pre-operative HCG levels, absence of FHB, absence of tuba! rupture nitially or minimal rupture may be considered suitable parameters for successful surgery and for achieving future pregnancy.