Ektopik gebeliğin yönetiminde genel hastane deneyimimiz: Tedavi seçiminde cerrahı etkileyen faktörler

Özet

Amaç: Hastanemizjinekoloji kliniğine başvuran ve ektopik gebelik tanısı alan hastaların yönetim ve sonuçlarını değerlendirmek. Materyel ve metod: Mart 2003 ve Mart 2005 tarihleri arasında Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi jinekoloji kliniğimize başvuran ve ektopik gebelik tanısı alan 85 olgu retrospektif olarak incelendi. 85 olgunun 62'si operatif, 17'si ekspektan ve 6'sı metotreksat ile tedavi edildi. Bulgular: Öpere olan, ekspektan yaklaşılan ve metotreksat tedavisi alan gruplar arasında ortalama yaş, gravida, parite, sistolik ve diastolik kan basıncı, nabız dakika sayısı, başlangıç serum hCG seviyesi ve hemoglobin değerleri açısından istatistiksel olarak anlamlı farklılık saptanmadı. Öpere olan olguların 38'ine (%61) laparatomi, 24'üne (%39) laparoskopi yapıldı. Öpere olan olgularda transvajinal ultrasonografide douglasta serbest sıvı varlığı %76(47/62), adneksial kitle varlığı %84(52/62) saptandı. Bu oran ekspektan yaklaşılan ve metotreksat tedavisi alan olgulara göre anlamlı derecede yüksek bulundu (p

Abstract

Objective: Evaluation of the administration and conclusions of the patients, who applied to our hospital's gynecology clinic and diagnosied as ectopic pregnancy. Materials and method: A retrospective study was performed for 85 cases of ectopic pregnancies, who applied to Zeynep Kamil Women and Children's Education and Research Hospital gynecology clinic between March 2003 and March 2005. Out of 85 patients, 62 cases were treated operatively, 17 were treated conservatively and 6 were treated with methotrexate. Results: There was no statistically significant difference on the avarage age, gravida, parity, sistolic and diastolic blood pressure, pulse rate per minute, begining serum hCG level and hemoglobin level between the groups who were operated or managed conservatively or treated with methotrexate . 38 cases (61%) had been treated with laparatomy and the other 24 (39%) had been treated laparoscopically. In operated cases, free liquid presence in douglas was detected 76%(47/62), adnexial mass presence was detected at 84%(52/62) at transvaginal ultrasound. This ratio was significantly high when compared with the cases treated conservatively and methotrexate therapy(p< 0.05). Conclusion: Ectopic pregnancy can be treated by operatively, conservatively and with methotrexate. Gynecological and physical examination, hemogram study and a careful ultrasonographic evaluation are major criterions to decide on which management to follow in treatment. At patients who have hemodinamically stable where surgical treatment has been chosen, we have observed that both laparatomy and laparoscopy have similar complication rate; therefore laparoscopy should be considered to be the first alternative due to the early ambulation and shorter stay at the hospital.