不同术式治疗输卵管妊娠后的生育结局研究

A study of the reproductive outcome after different surgical management of tubal pregnancy

目的探讨使用不同术式和手术方法治疗输卵管妊娠后患者的生育结局及其影响因素。方法回顾性分析256例输卵管妊娠妇女经手术治疗后的生育状况,比较剖腹手术与腹腔镜手术、输卵管保守手术与切除手术之间的区别。结果宫内妊娠率在开腹手术组为27.0%,在腹腔镜手术组为51.1%,重复性异位妊娠在开腹手术组为39.7%,在腹腔镜手术组为18.0%。两组不孕率分别是33.3%和30.9%,两者比较差异有显著性(P<0.01)。宫内妊娠率在输卵管保守手术组为50.0%,在输卵管切除组为22.4%,重复性异位妊娠率在输卵管保守手术组为21.7%,在输卵管切除组为34.5%。不孕在两组分别是28.3%和43.1%,两者比较差异有显著性(P<0.01)。在去除了引起异位妊娠的相关因素后,宫内妊娠率明显增加,而不孕率和重复性异位妊娠率明显降低。结论在影响输卵管妊娠手术治疗后生育结局的因素中,腹腔镜手术明显优于开腹手术,保留输卵管的手术明显优于输卵管切除术。如患者没有引起输卵管妊娠的相关因素,则其生殖预后良好。

[Objective] To investigate the reproductive outcome and it＇s influencing factors after different surgical management of tubal pregnancy. [Methods] A retrospective study was carried out to analyse the reproductive outcome of women after different surgical management of tube pregnancy. [Results] The intrauterine pregnancy rate is 27.0% in laparotomy group and 51.5% in laparoscopy group. The recurrent ectopic pregnancy rate is 39.7% in laparotomy group and 18.0% in laparoscopy group. The infertility rate is 33.3% in laparotomy group and 30.9% in laparoscopy group. There is a statistic significance between laparotomy and laparoscopy group （P 〈0.01）. The intrauterine pregnancy rate is 50.0% in conservative tubal surgery group and 22.4% in salpingectomy group. The recurrent ectopic pregnancy rate is 21.7% in conservative tubal surgery group and 34.5% in salpingectomy group. The infertility rate is 28.3% in conservative tubal surgery group and 43.1% in salpingectomy group. There is a statistic significance between consevative tubal surgery group and salpingectomy group （P 〈0.01）. The reproductive outcome is better in women without risk factors such as previous pelvic infection, fallopian tube pathology than women with it. [Conclusions] Considering the reproductive outcome in women with tubal pregnancy, laparoscopy is better than laarotomy in the management of tubal pregnancy, Conseavative tubal surger）, is better than salpingectomy in the management of tubal pregnancy. Women without risk factor related to ectopic pregnancy may have a better prognosis for reproductive outcome.