Takeda Akihiro, Manabe Shuichi, Mitsui Takashi, Nakamura Hiromi
Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.
J Minim Invasive Gynecol. 2006 Jan-Feb;13(1):43-8. doi: 10.1016/j.jmig.2005.09.100.
To evaluate the feasibility and safety of surgical laparoscopy with intraoperative autologous blood transfusion for ectopic pregnancy with massive hemoperitoneum.
Retrospective analysis (Canadian Task Force classification II-1).
Department of gynecology at a general hospital.
Seventeen consecutive patients with ectopic pregnancy with massive hemoperitoneum.
Laparoscopic surgery with salvage device-based intraoperative autologous blood transfusion.
From January 2000 through June 2005, one hundred and twelve women with ectopic pregnancy (interstitial/cornual: 4; isthmic: 18; ampullary: 86; and ovarian: 4) were treated by laparoscopic surgery. Seventeen patients who demonstrated more than 501 g of intraabdominal bleeding were classified as having massive hemoperitoneum and retrospectively analyzed. Site of pregnancy in these 17 patients was interstitial/cornual: 3; isthmic: 5; ampullary: 7; and ovarian: 2. Except for two women with tubal abortion of ampullary pregnancy, all other patients had rupture at the pregnancy site. During laparoscopic surgery, blood pooled in the abdominal cavity was collected by an irrigation and aspiration procedure, and sent to an autologous blood-salvage device to make concentrated red blood cell solution. Processed blood was immediately transfused back to the patient through a leukocyte reduction filter. The mean amount of estimated intraabdominal bleeding, which was calculated by the difference between the volumes of aspirated and irrigated fluids, was 1362.1 +/- 491.4 g, and the mean volume of reinfused processed blood was 680.6 +/- 209.5 g. No patient received banked blood at any time. The degree of hemoperitoneum was well correlated with the shock index calculated by dividing the heart rate by systolic blood pressure at triage (r = 0.72; 95% CI 0.37-0.89; p = .001). In all cases of massive hemoperitoneum, there was no need for laparotomic conversion, and homologous blood transfusion was avoided.
Even in women with ectopic pregnancy with massive hemoperitoneum, laparoscopic surgery can be safely conducted by experienced laparoscopists with intraoperative autologous blood transfusion if hemodynamic stability is achieved by perioperative management.
评估手术腹腔镜检查联合术中自体输血治疗伴有大量腹腔内出血的异位妊娠的可行性和安全性。
回顾性分析（加拿大工作组分类II-1）。
一家综合医院的妇科。
17例连续的伴有大量腹腔内出血的异位妊娠患者。
采用基于挽救装置的术中自体输血的腹腔镜手术。
2000年1月至2005年6月，112例异位妊娠妇女（间质部/宫角部：4例；峡部：18例；壶腹部：86例；卵巢：4例）接受了腹腔镜手术治疗。17例腹腔内出血超过501g的患者被归类为有大量腹腔内出血，并进行回顾性分析。这17例患者的妊娠部位为间质部/宫角部：3例；峡部：5例；壶腹部：7例；卵巢：2例。除2例壶腹部妊娠输卵管流产的妇女外，所有其他患者妊娠部位均发生破裂。在腹腔镜手术期间，通过冲洗和抽吸程序收集腹腔内积聚的血液，并将其送至自体血液挽救装置以制成浓缩红细胞溶液。处理后的血液通过白细胞滤除器立即回输给患者。通过抽吸液和冲洗液体积之差计算的估计腹腔内平均出血量为1362.1±491.4g，回输的处理后血液平均体积为680.6±209.5g。没有患者在任何时候接受库血输血。腹腔内出血程度与分诊时心率除以收缩压计算的休克指数密切相关（r = 0.72；95%CI 0.37-0.89；p = 0.001）。在所有大量腹腔内出血的病例中，均无需转为开腹手术，且避免了异体输血。
即使是伴有大量腹腔内出血的异位妊娠妇女，如果通过围手术期管理实现血流动力学稳定，经验丰富的腹腔镜手术医生也可以在术中进行自体输血的情况下安全地进行腹腔镜手术。
