بررسی محاسن و معایب عمل جراحی لاپاراسکوپی در درمان بارداری لوله‌ای

    Background & Aim: Ectopic pregnancy is still considered one of the major diagnostic and therapeutic problems in obstetrics and gynecology which may result in mortality and infertility in some cases. The aim of the present study was to evaluate benefits such as maintenance of fertility and risks such as obligation of laparatomy resulted by laparascopic surgery that is quite new in our country. Patients & Method: In this historical cohort survey, 101 ectopic pregnancy patients admitted to gynecologic endoscopy ward of Rasoul-e-Akram Hospital from 1995-2003 were studied. Data collection was performed by checklists prepared through patients’ medical records. Results: Involved tube was saved in 88 cases and salpingectomy was performed on 13 cases.There were 2 cases of postoperative bleeding that needed second laparascopy and one case needed laparatomy. Postoperative infection caused laparatomy in one more case. Two more cases underwent laparatomy in another center. There was one case of β-hCG rise after surgery that underwent chemotherapy. The rate of pregnancy after laparascopy was 58% in 37 patients with desire for childbearing, and the rate of recurrent EP in the involved and contralateral tube was 7% in total. Conclusion: Ectopic pregnancy is one of the most common emergencies in obstetrics and gynecology which should be considered as one of the differential diagnoses of acute abdomen in women of fertility age. The kind of treatment depends not only on the age and desire of the patient for more pregnancies but also on the gestational age and other findings during laparascopy. It is obvious that in older patients with no intention for pregnancy, the preferable method is simple salpingectomy by cautery, laser or 3-loop method. Conservative surgery for ectopic pregnancy carries the risk of recurrence, so the patient and her family should be aware and sign the consent form. 14 of the 101 patients had positive history of tubal surgery due to ectopic pregnancy(table 1) and new EP happened in the same or the other tube. Although some studies deny this risk, recurrence is a fact that depends to some extent on the method and kind of surgery.