Author/Editor		Ribič-Pucelj, M; Tomaževič, T; Vogler, A; Zupan, P
Title		Laparoskopsko operiranje zunajmaternične nosečnosti
Translated title		Laparoscopic treatment of ectopic pregnancy
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 64, št. 1
Publication year		1995
Volume		str. 17-20
Language		slo
Abstract		Background. The introduction of modern diagnostic procedures, such as ultrasonographic examination (US) and determination of beta subunit of chorionic gonadotropin (beta HCG) in serum, have provided the detection of early, still unruptured ectopic pregnancy (EP), and also laparoscopic approach to its treatment. The paper presents our experience and results of laparoscopic surgery of EP. Methods. From November 1990 to 31 December 1993 laparoscopic surgery was performed on 222 patients with EP at the Reproduction Unit, Department of Obstetrics and Gynaecology, Ljubljana. The patients' age ranged from 18 to 41 years. Beta HCG value on the day of surgery ranged from 250 to 58000 mIU/ml, the size from 1 to 6 cm, and gestational age from 5 to 10 weeks. The diagnosis was based on the serum beta HCG determination and US vaginal examination and was confirmed by laparoscopy which was applied as a surgical procedure at the same time. Three-puncture technique was used. The type of surgery of the affected tube depended on the patient's age, on her wish to preserve fertility, the size of EP, and the degree of tubal damage. Various techniques were used in operations of the tubes: monopolar electrode, CO2 laser, bipolar forceps and scissors, and endo-loop. Results. Until 1988 the only method for treating EP was the open surgical approach through laparotomy. That year we introduced medical treatment with prostaglandin E2(PGE2S)(Prostin E2S Upjohn), which was under the control of laparoscope injected in the affected tube. This method of treatment decreased the incidence of laparotomy for ove r 50 percent. In November 1990 EP was removed laparoscopically for the first time. This surgical approach soon replaced other methods of treatment. In 1991 68 percent of patients underwent laparoscopic surgery and in 1992 and 1993 already 94,5 percent of patients.(trunc.)
Summary		Izhodišča. Uvedba sodobnih diagnostičnih postopkov, kot sta vaginalna ultrazvočna (UZ) preiskava in določanje podenote beta horionskega gonadotropina (beta HCG) v serumu, je omogočila odkrivanje zgodnje, še ne rupturirane zunajmaternične nosečnosti (ZN) ter laparoskopski kirurški pristop k zdravljenju te bolezni. Delo prikazuje naše izkušnje in rezultate laparoskopskega operiranja ZN. Metode. Od novembra 1990 do 31. decembra 1993 smo na Enoti za reprodukcijo Ginekološke klinike v Ljubljani laparoskopsko operirali 222 bolnic z ZN, starih od 18 do 41 let. Vrednost beta HCG na dan posega je bila od 250 do 58000 mIU/ml, velikost od 1 do 6 cm, gestacijska starost pa od 5 do 10 tednov. Diagnozo smo postavili na osnovi vrednosti beta HCG v serumu in vaginalne UZ preiskave ter jo potrdili z laparoskopijo, ki je bila obenem tudi kirurška metoda. Uporabili smo tehniko treh vbodnih mest. Vrsta operacije na prizadetem jajcevodu je bila odvisna od starosti bolnice, želje po ohranitvi plodne sposobnosti, velikosti ZN in stopnje okvare jajcevoda. Pri operacijah na jajcevodu smo uporabili različne tehnike: monopolarno elektrodo, CO2 laser, bipolarno pinceto in škarje ter endo zanko. Rezultati. Odprt kirurški pristop skozi laparotomijo je bil edini način zdravljenja ZN do leta 1988, ko smo uvedli medikamentozno zdravljenje ZN s prostaglandinom E2(PGE2(Prostin E2 Upjohn), ki smo ga pod kontrolo laparoskopa vbrizgali v prizadeti jajcevod. Ta način zdravljenja je zmanjšal pogostost laparotomije za več kot 50 odst.. Novembra 1990 smo ZN prvič laparoskopsko operirali. Ta kirurški pristop je hitro nadomestil ostale načine zdravljenja. Leta 1991 smo laparoskopsko operirali 68 odst. bolnic, leta 1992 in 1993 pa že 94,5 odst.. Najpogostejša operacija na prizadetem jajcevodu je bila vzdolžna incizija - tubotomija in odstranitev nosečnosti, in sicer pri 118 (53,1 odst.) bolnicah. Pri 101 (45,5 odst.) bolnici smo naredili tubektomijo - odstranitev prizadetega jajcevoda.(krajš.)
Descriptors		PREGNANCY, ECTOPIC LAPAROSCOPY