当院における異所性妊娠大量出血症例の手術成績と管理の現状

抄録

Objective: We aimed to evaluate the clinical and surgical results for ectopic pregnancy (EP) in patients with massive hemoperitoneum.

Materials and Methods: We evaluated the incidence, sites of implantation, clinical results, and surgical procedures of EP in patients with more than 500 ml of hemoperitoneum from January 2002 to September 2020 at Fukushima Red Cross Hospital.

Results: During the study, 250 patients with EP were treated surgically, including 36 (14.4%) with massive hemoperitoneum (≥500ml). The hemoperitoneum volume were as follows: 500~999 ml, 24 cases (9.6%); 1,000~1,999ml, 10 cases (4.0%); and ≥2,000ml, 2 patients (0.8%). Laparoscopic surgery was performed in all patients except in 1 with ovarian pregnancy who was preoperatively suspected of having ovarian bleeding at 5 weeks of gestation. Among 19 most recent cases in the present study, tubal ruptured occurred in 60% (100% in isthmus and 40% in ampulla). There were large variations in preoperative serum hCG level. Three of 8 patients (37.5%) with a hemoperitomeum volume over 1,500 ml had a shock index <1.

Conclusion: There was a poor relationship between hemoperitoneum and both preoperative vital signs and s-hCG level. Transvaginal and transabdominal ultrasonography examination may be the most useful tools for estimating hemoperitoneum volumes. Laparoscopic surgery is a useful and effective option when the patients are hemodynamically stabilized preoperatively and strictly monitored by senior anesthesiologist intraoperatively, then performed by surgeon with laparoscopic surgical skill and expertise, considering with risk factors such as obesity and severe adhesion. Salpingectomy is the treatment choice in patients with massive hemoperitoneum.