Treatment of ectopic pregnancy

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 opened 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 microsurgery is used in the operation, the subsequent pregnancy rate can be improved. In addition to laparotomy, conservative surgery can also be performed through laparoscopy.

Surgical treatment:

The principle of treatment for tubal pregnancy is mainly surgical treatment, and surgery should be performed immediately after diagnosis. The surgical method generally adopts total salpingectomy. Those who require 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 method is selected according to the patient's general condition, the implantation site of the fertilized egg and the degree of fallopian tube lesions. For example, in case of fimbria pregnancy, the fertilized egg is pressed out, and in case of ampulla pregnancy, the fertilized egg is removed by incision. In case of isthmus pregnancy, lesion resection and stump anastomosis can be performed. The use of microsurgical technology can improve the pregnancy rate.

Treatment of tubal interstitial pregnancy can be performed by resection of the affected uterine horn or total hysterectomy according to the pathological condition. 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, no blood contamination, red blood cell rupture rate under the microscope <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.

Note:

1. When women have lower abdominal pain, they must be alert to ectopic pregnancy

2. Ectopic pregnancy is a more serious disease than abortion. As the fetus grows, the fallopian tube will rupture and cause heavy bleeding, which threatens not only the fetus but also the mother's life.

3. There is a saying among obstetricians and gynecologists: "Typical ectopic pregnancy is the least typical." Because the symptoms of ectopic pregnancy are often vague, patients should report every detail since the onset of the disease to their doctors.

4. Ectopic pregnancy can be easily confused with other abdominal pain problems, so you should be careful to distinguish them. Intussusception is severe abdominal pain with blood in the stool; the pain of appendicitis starts from the heart and gradually moves to the right lower abdomen; intestinal volvulus is sudden pain and bloating; gallstones are right upper abdominal pain, while ectopic pregnancy, that is, ruptured pregnancy outside the uterus, is severe pain in the lower abdomen and bleeding.

Chemotherapy:

It is mainly suitable for young patients with early ectopic pregnancy who want to preserve their fertility. It is generally believed that this method can be used if the following conditions are met:

① The diameter of the tubal pregnancy mass is less than 3cm;

② The tubal pregnancy has not ruptured or miscarried;

③No obvious internal bleeding;

④ Blood HCG <2000U/L. Chemotherapy is generally performed by systemic medication, but can also be performed locally. Methotrexate (MTX) is commonly used for systemic medication. The treatment mechanism is to inhibit trophoblast proliferation, destroy villi, and cause embryonic tissue necrosis, shedding, and absorption to avoid surgery. The usual dose is 0.4mg/kg.d, intramuscular injection, and a course of treatment is 5 days. The application of chemotherapy may not be successful in every case, so B-ultrasound and HCG should be used for close monitoring during treatment, and attention should be paid to changes in the patient's condition and the toxic and side effects of the drug.

If HCG decreases and is negative for three consecutive times 14 days after medication, abdominal pain is relieved or disappears, and vaginal bleeding is reduced or stopped, it is considered effective. If the condition does not improve, or even acute abdominal pain or tubal rupture occurs, surgical treatment should be performed immediately. Local medication can be injected directly into the gestational sac of the fallopian tube by puncture under the guidance of B-type ultrasound, or by puncturing the gestational sac of the fallopian tube under direct laparoscope vision, sucking out some cystic fluid, and then injecting the drug into it. Currently, the commonly used drug is still MTX.

Ectopic pregnancy: http://www..com.cn/fuke/gwy/