A surgical therapy
(A) tubal resection: whether abortion-or fallopian tube ruptured tubal pregnancy can be removed in a timely manner to save lives bleeding children no longer have the women's fertility can be prepared simultaneously in the opposite tubal ligation need to retain the fertility of women if tubal lesions Break too long and too much loss of the fallopian tube membrane and blood vessels and / or indications of life in a serious state of a fallopian tube should be removed in line conservative surgery tubal bleeding can not control the fallopian tube should be immediately removed
Zhenma surgery can be carried out under local anesthesia or Caesarean section after the first stop bleeding with pliers Qianzhu bleeding to stop bleeding shock at the rapid blood transfusion to be improved after the shock of the steps by the side of salpingectomy as normal ovarian side should be retained as the contralateral With the normal requirements of tubal sterilization should be implemented ligation contralateral Luanguan patients with lesions in accordance with requirements of the situation and deal with lesions in principle, be best to shorten the operation time period should not be in acute bleeding or inflammation under consideration lose eggs was performed abdominal Free no infected blood for their own blood transfusion especially in the case of lack of blood transfusion for their rescue hemorrhagic shock is extremely effective measures at this time no blood coagulation is not thick with the smell no destruction of red blood cells under the microscope of not more than 30 percent each 100ml of blood plus 3.8% sodium citrate 10 ml of their blood should be more than 500 ml to 10 percent calcium gluconate 10 ~ 20 ml citrate to avoid poisoning with autologous blood transfusion without the timely added to internal bleeding and more serious hemorrhagic shock patients is very necessary Savings of the blood and reduce the financial burden of their fresh red blood cell can also avoid carrying ability of serum hepatitis and other infectious diseases in recent years some people put their own blood anticoagulant and may increase the clinical application of the recovery of the blood coagulation degree of People vary in order to give full play to the advantages of their own blood transfusion or increase sodium citrate or ACD solution suitable anticoagulant
(B) conservative surgery: the so-called conservative surgery to remove the heart is, in principle, as much as possible to retain tubal pregnancy of the anatomy and function to create the conditions for the future of intrauterine pregnancy
Indications: young women of this tubal pregnancy as the first pregnancy; children have been removed without the side tubal
Surgery: fallopian tube embryos incision removal of swelling in the affected parts of the film in the longitudinal axis parallel to the surface and tubal 1 ~ 2 cm incision gently squeezed out of pregnancy will then fine silk thread or 0 / 8 non-invasive sutures under the microscope Sutured incision will be used for that is not slit window closed incision and margin will be interrupted suture to stop bleeding into a "window" of pregnancy if, for the isthmus, with end-to-end anastomosis isthmus lesions near the corner of uterine tubal possible angle implantation in the uterus
To prevent postoperative adhesions retain fertility is one of the important measures can be placed in the abdominal cavity in the molecular dextran 250 ~ 300 ml, or 0.25 percent procaine 100 ml hydride de-250 mg glycerin 10 ml after the restoration of fertility treatment also very important If timely tubal-water treatment, such as promoting blood circulation decoction
(C) laparoscopic surgery: first used in laparoscopic for washing and flushing aspiration of blood found in the pelvic Yunluan implantation sites such as ampulla of pregnancy may be directly from the ampulla (the umbrella Division), or suction out tbsp Clamp to pregnancy, such as the Gap or the Department of the Ministry of tubal pregnancy would do in the incision of the vaccination of mesangial 5% POR-8 20 ~ 30ml to prevent ischemia, bleeding in the open Luanguan Luanguan dorsal Luanguan uplift the coagulation after the cut until the egg wall of pregnancy exposed by two non-invasive equipment, left the egg wall later tbsp clamp of pregnancy will gradually remove the final wash-rinse with implantation sites with Abdominal knot of suture to close the wound Luanguan serous
The Integrated Treatment
According to 8 are satisfied that the dialectic of tubal pregnancy, abdominal pain on blood-wook is unreasonable in promoting blood circulation Quyu should therefore be to the principle of pain for the treatment of patients with cold and heat actual situation Syndrome addition and subtraction and clinical classification (shock of stable mass-type) medication
(A) shock-type: hemorrhage shock stage more attention should be paid to actual situation both at the same time take into account the constitution of cold and heat as a result of tubal pregnancy itself is of internal bleeding and blood pressure to drop cold sweat looking pale and weak pulse to Xu Zheng according to an analysis of patients at the time such as Xu Zheng Air heavier use ginseng to prevent blood deficiency at the same time accompanied by promoting blood circulation to promote internal bleeding absorption Quyu
Recipe: Salvia 30 g TPG 10 g Taoren 10 g frankincense 10 g myrrh 10 g water to cook 300 ml in two virtual clothes were heavy and severe pain ginseng Canadian dollar rescue shock at the same time Hu and oxygen blood transfusion insulation to keep in systolic blood pressure-about 12 kpa
In the course of treatment to closely observe the pulse of blood pressure patients, such as abdominal pain and hemoglobin clear whether or not to continue to hemorrhage; patients with bed rest must be absolutely not too early to minimize activities of a sudden increase in abdominal pressure and body position changes in the factors that should be able to have blood transfusions and Caesarean section at any time the conditions Under this type of immediate treatment to individual patients with abdominal surgery has repeatedly refused to consider surgery again
(B) stable: a stable condition stable blood pressure to reduce abdominal pain free blood has been initially formed part of absorption or mass anti-abdominal tenderness Zhuoyin Tiaotong reduce the mobility of the gradual disappearance of vaginal examination may be touched on the main mass in accordance with the appropriate antidote to heat If Baicalin two-plus spent to prevent infection, such as Forsythia this period of bed rest is still mainly gradually appropriate activities
(C) mass-type: This type of blood stasis Positive microgastropods a mass in addition to promoting blood circulation by removing blood stasis, the main side should be broken by the Kennedy plot to eliminate mass of drug use good break Zhengjia the Tri-Ezhu it should be noted Tri-Ezhu tackling tough problems such as the use of drugs such as the length of this may have caused Deficiency Syndrome should be based on symptoms such as pulse to dangshen Astragalus Air drugs to accelerate the mass to absorb external application can be soft Kennedy ointment: 15 g of the maple wood turtle-15 g aeruginosa 15g increase to date 10 nuclear research Ximo were evenly mixed with gauze wrap placed lower abdomen plus hot packs or musk 0.6 g camphor 6 g's Blood 9 g Rosin 9 g Yin-Zhu 9 g total of four flavor drug research Ximo share buy cloth pieces On the plate of the last to join with musk, the mass affixed to the lower abdomen
Yunluan absolutely not in the positive pregnancy test can be added to the centipede two Achyranthes 15 g trichosanthin 9 ~ 15 g teeth soap 9 g to eliminate the embryo so that pregnancy tests were negative but the results may also not very happy with the β-hCG and monitoring the treatment of B - Can also increase use of MTX must accelerate Yunluan
Three drug treatment
Methotrexate (methotrexateMTX) is mainly used for non-ruptured tubal pregnancy tubal serous integrity of active bleeding tubal pregnancy product of the diameter of <3 ~ 4 cm abdominal blood in the <100 ml β-hCG <3000mIU/ml vital signs are stable young require fertility
Treatment methods: ① MTX oral 0.4 mg (kg d) 5 days for a general course of the amount of 25 mg / d by five days without clinical toxicity rarely applied; ② MTX intramuscular injection 0.4 mg / (kg d) 5 days for a A course of the authors report 23 cases of ectopic pregnancy after absorbing 95.7 percent of pregnant or laparoscopic confirmed by contrast 10/19 (52.6%) patients with tubal patency; ③ MTX-CF programme formyl Relationship (citrovorum factorCF) CF can be reversed MTX toxicity of the most commonly used method for the current MTX when the dosage of 1 mg / kg, plasma concentration of 10-8 M to be rescued by CF to achieve high efficacy and toxicity MTX infusion time
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