Ectopic pregnancy surgery

Ectopic pregnancy refers to the fertilized egg being affected by certain factors and implanting and developing in places outside the uterine cavity, such as the fallopian tube, uterine horn, abdominal cavity, ovary, etc. Because the implantation site is narrow and thin-walled, it cannot expand fully and cannot accommodate the growth and development of the fertilized egg, making it easy for the embryo to pass through the wall tube, destroying the blood vessels and causing heavy bleeding. Ectopic pregnancy develops rapidly, is serious, and can be life-threatening if not properly handled. Therefore, women of childbearing age should learn to self-diagnose ectopic pregnancy.

Surgical treatment: The treatment principle of ectopic pregnancy is mainly surgical treatment. There are two types of surgical treatment methods. One is to remove the affected fallopian tube; the other is to retain the affected fallopian tube, which is conservative surgery.

Conservative surgery is suitable for young women who want to have children, especially those whose contralateral fallopian tube has been removed or has obvious lesions. In recent years, due to the improvement of diagnostic technology, more and more tubal pregnancies have been diagnosed before miscarriage or rupture, so the use of conservative surgery has increased significantly compared with the past.

The surgical procedure is selected according to the implantation site of the fertilized egg and the condition of the fallopian tube lesions. If it is an infundibulum pregnancy, the pregnancy products can be squeezed out; if it is an ampulla pregnancy, the fallopian tube is cut open to remove the embryo and then sutured; if it is an isthmus pregnancy, the diseased segment is resected and end-to-end anastomosis is performed. If the operation uses microsurgery technology, the subsequent pregnancy rate can be improved. In addition to laparotomy, conservative surgery can also be performed through laparoscopy.

Surgical treatment: The treatment principle of tubal pregnancy is mainly surgical treatment, which should be performed immediately after diagnosis. The surgical method generally adopts total salpingectomy. Those who want sterilization can be ligated at the same time. Young women who want to have children on the other side of the fallopian tube can undergo conservative surgery to preserve the fallopian tube and its function if the other side of the fallopian tube has been removed or has obvious lesions.

The surgical procedure is selected according to the patient's general condition, the site of fertilized egg implantation, and the degree of fallopian tube lesions. For example, in case of fimbria pregnancy, fertilized egg extrusion is performed, ampulla pregnancy is performed, and incision is performed to remove the fertilized egg. In case of isthmus pregnancy, lesion resection and stump anastomosis can be performed. Microsurgical techniques can be used to improve the pregnancy rate. The treatment of interstitial tubal pregnancy can be performed by resection of the affected uterine horn or total hysterectomy according to the lesion. In recent years, laparoscopic diagnosis and treatment of tubal pregnancy have been carried out at home and abroad. Autologous blood transfusion is one of the effective measures to rescue acute ectopic pregnancy, especially in the absence of blood source. The recovery of intraperitoneal blood must meet the following conditions: pregnancy <12 weeks, no rupture of membranes, bleeding time <24 hours, blood is not contaminated, and the red blood cell rupture rate under the microscope is <30%.

Minimally invasive treatment of ectopic pregnancy:

In recent years, minimally invasive laparoscopic technology has become increasingly mature and widely used in the field of obstetrics and gynecology, making the treatment of ectopic pregnancy move from "major trauma" to "minimally invasive". Because of its small surgical trauma, less bleeding, short operation time, fast postoperative recovery, short hospitalization time, almost no scars on the abdomen, less pelvic adhesions, mild fallopian tube obstruction, it is easier to preserve the fallopian tube. Tissue coagulation of the wound surface can prevent the exudation and deposition of cellulose, and significantly improve the patient's quality of life after surgery. It is very popular among patients.

The most advanced laparoscope in the world uses cold light sources to provide illumination. The laparoscope lens (3-10mm in diameter) is inserted into the abdominal cavity. The digital camera technology is used to transmit the images captured by the laparoscope lens to the post-stage signal processing system through optical fibers and display them in real time on a dedicated monitor. The doctor then analyzes and judges the patient's condition through the images of the patient's organs from different angles displayed on the monitor screen, and uses special laparoscopic instruments to perform surgery.

During the operation, only three 0.5-1 cm small holes need to be opened in the patient's abdomen. After recovery, only 1-3 0.5-1 cm linear scars are left in the abdominal cavity, which are only the size of a keyhole. It can be said that this is a surgery with small wounds and little pain. The development of Stryker laparoscopic surgery has reduced the pain of surgery for patients, shortened the recovery period of patients, and relatively reduced the cost of patients. The most important thing is that it can effectively preserve the fallopian tubes. The fallopian tube preservation rate is as high as 95.65%, creating favorable conditions for future childbearing, which is very suitable for women with childbearing requirements.

Ectopic pregnancy care:

1. Psychological care

In response to the patient's anxiety and fear, nursing staff should show understanding and sympathy, patiently comfort the patient, relieve the patient's psychological pressure, obtain the cooperation of the patient and his family, make them trust, feel safe, and accept treatment with a good attitude.

2. Maintain effective gastrointestinal decompression

Effective gastrointestinal decompression is essential to reduce intestinal pressure, improve intestinal blood circulation, and reduce intestinal absorption of bacterial toxins. Therefore, during gastrointestinal decompression, the amount, properties, and color of drainage should be closely observed, the gastrointestinal decompression tube should be properly fixed, and effective negative pressure should be maintained. 30 ml of liquid paraffin should be injected into the gastric tube every 6 hours, and the tube should be clamped for 30 minutes before being opened.

3. Do a good job in diet and activity education

Patients with intestinal obstruction should fast and not drink, and receive appropriate fluid replacement, enhanced nutrition, and maintenance of water and electrolyte balance. If the obstruction is relieved and the patient's flatulence, bowel movements, abdominal pain, and bloating disappear, they can eat liquid food 12 hours later, but should avoid sweets and milk. Eat small meals frequently, chew slowly, and avoid overeating. Eat semi-liquid food after 24 hours and soft food after 3 days. The transition should be gradual. If there are no contraindications after surgery, encourage patients to get out of bed and move around early. According to the patient's tolerance, gradually increase the amount and range of activity to promote recovery of gastrointestinal function.

4. Strengthen oral care

Patients are weak after major surgery and have fasted for many days. Their saliva secretion is reduced and their oral mucosa is dry. Nurses should choose appropriate oral care solutions and perform oral care in a timely manner to prevent and reduce the growth of oral bacteria.

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