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[Laparoscopic surgery in patients with hypovolemic shock due to ectopic pregnancy]
Zhigang Li1, Jinhua Leng, Jinghe Lang
1Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.
Objective:
To evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock.
Methods:
Two hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. These patients were divided into two groups. Group I included 21 patients of ectopic pregnancy with shock and intraperitoneal hemorrhage more than 1,000 ml, and group II included 194 hemodynamically stable patients with blood loss less than 1,000 ml. The clinical data of perioperative periods in two groups were analyzed.
Results:
All patients were tube pregnancies. The rate of tube rupture was higher in group I than that in group II (81% versus 16%), the difference was statistically significant (P < 0.01). Intraabdominal blood loss was significantly higher in group I (1,775 +/- 531) ml than that in group II (133 +/- 176) ml, autologous blood transfusions were given to 95% and 9% of patients in group I and II respectively (P < 0.01). Laparoscopic salpingectomy was performed to 86% and 51% of patients in group I and II, the difference was significant. The operating time was longer in group I than in group II (50 +/- 24) and (43 +/- 24) min, but the difference was not significant. All patients had no perioperative complications.
Conclusions:
Operative laparoscopy in patients with hypovolemic shock can be safely and effectively performed by experienced laparoscopists with the aid of optimal anesthesia, advanced cardiovascular monitoring and autologous blood transfusion.