精细化经脐单孔腹腔镜输卵管开窗取胚术的临床价值

Clinical value of refined transumbilical single-port laparoscopic fallopian tubal fenestration and protective value of tubal fertility

目的探讨精细化经脐单孔腹腔镜输卵管开窗取胚术的安全性及有效性,以及对输卵管生育力保护的临床价值。方法收集宁夏医科大学总医院妇科行输卵管开窗取胚术治疗的未破裂型异位妊娠患者的临床资料,依据患者手术方式不同分为精细化单孔腹腔镜组(A组30例)、单孔腹腔镜组(B组30例)和多孔腹腔镜组(C组35例)。所有患者均通过术后病理检查明确诊断为输卵管妊娠。比较三组之间手术时间、术中出血量、术后排气时间、术后首次下床活动时间、术后疼痛视觉模拟评分(visual analogue scale,VAS)、再次输卵管妊娠发生率及宫内妊娠率。结果95例输卵管妊娠患者均顺利完成腹腔镜下开窗取胚术,无中转开腹或腹腔镜下切除患侧输卵管,在手术时间、术中出血量、术后排气时间、术后首次下床活动时间、术后VAS评分方面组间比较,A组均明显优于B、C两组,差异有统计学意义(P<0.05);两两比较,手术时间在A组与C组之间无统计学差异(P>0.05),A组与B组、B组与C组之间均具有统计学差异(P<0.05);术中出血量、术后排气时间、术后VAS评分等方面三组组间比较均具有统计学意义(P<0.05);首次下床活动时间方面,A组与C组之间比较差异有统计学意义(P<0.05),A组与B组、B组与C组之间无统计学意义(P>0.05);腹部切口美观度方面,与C组比较,A、B组在术后明显偏高,差异有统计学意义(P<0.05);术后满意度方面,三组比较差异无统计学意义(P>0.05);术后对患者随访1年,术后输卵管通畅度评估及妊娠情况比较分析,与B、C组相比,A组总输卵管通畅度及宫内妊娠率稍高,但差异无统计学意义(P>0.05),再次输卵管妊娠发生率明显偏低,差异有统计学意义(P<0.05)。结论精细化经脐单孔腹腔镜输卵管开窗取胚术安全且疗效显著,能降低输卵管性不孕的发生率,可提高患者输卵管生育力。

Objective To explore the safety and effectiveness of refined transumbilical single-port laparoscopic fallopian tubal fenestration as well as the clinical value of tubal fertility protection.Methods The clinical data of patients with unruptured ectopic pregnancy treated by single-port laparoscopy and traditional four-port laparoscopic tubal fenestration in the Gynecology Department of General Ningxia Medical University were collected,and they were divided into the refined single-port laparoscopic group(30 cases in group A),the single-port laparoscopy group(30 cases in group B)and the multi-port laparoscopy group(35 cases in group C)according to the different surgical methods of patients.All patients were clearly diagnosed with tubal pregnancy by postoperative pathological examination.The operation time,intraoperative blood loss,postoperative exhaust time,postoperative first time out of bed activity,postoperative VAS score,follow-up retubal pregnancy incidence and intrauterine pregnancy rate were compared between the three groups.Results All 95 pregnant patients with tubal pregnancy successfully completed laparoscopic fenestration embryo retrieval,without transfer laparotomy or laparoscopic resection of the affected fallopian tube.In terms of operation time,intraoperative blood loss,postoperative exhaust time,postoperative first getting out of bed activity time,postoperative VAS score,group A was significantly better than groups B and C,the differences were statistically significant(P<0.05).There were significant differences between group B and group C(P<0.05).The comparison between the three groups in terms of intraoperative bleeding,postoperative exhaust time and postoperative VAS score was statistically significant(P<0.05),and the difference between group A and group C was statistically significant(P<0.05)in terms of activity time for the first time out of bed(P<0.05),and there were no significant significances between group A and group B,and between group B and group C(P>0.05).In terms of operation time,intraoperative blood loss,postoperative exhaust time,postoperative first out of bed activity time,and postoperative VAS score,group A was significantly better than the B and C groups.In group B,the operation time and intraoperative blood loss were significantly higher than those in group C,and the postoperative exhaust time,postoperative first out of bed activity time,and postoperative VAS score were significantly better than those in group C,and the differences were statistically significant(P<0.05).Compared with group C,groups A and B had significantly higher postoperative abdominal incision aesthetics(P<0.05),and postoperative satisfaction was not statistically significant(P>0.05).After one year of postoperative follow-up,postoperative tubal patency evaluation and comparative analysis of pregnancy situation showed that,compared with groups B and C,group A had higher total tubal patency and intrauterine pregnancy rate,but the difference was not statistically significant(P>0.05),the incidence of re-tubal pregnancy was significantly lower and statistically significant(P<0.05).Conclusion Refined single-port laparoscopic tubal window embryo retrieval is safe and effective,can reduce the incidence of tubal infertility,and can improve the fertility of the fallopian tubes.Refined transumbilical single-port laparoscopic tubal fenestration is safe and effective,can reduce the incidence of tubal infertility,and can improve the fertility of the fallopian tubes.