腹腔镜手术保护输卵管妊娠术后生殖状态的价值

Value of laparoscopic treatment at preserving fertility in patients with tubal pregnancy

目的探讨腹腔镜手术保护输卵管妊娠患者术后生殖状态的价值。方法回顾性分析两家医院1999年1月～2004年1月收治的经手术治疗的有生育要求并成功随访的424例输卵管妊娠患者的临床资料,分腹腔镜组293例和开腹组131例,选取其中无不良病史无输卵管粘连的患者及有输卵管手术史的患者,运用χ2检验的方法比较两组患者生育结局的差异。结果在整体患者及无不良病史无输卵管粘连的136例患者中,腹腔镜组较开腹组有更高的宫内妊娠几率及较低的重复性异位妊娠几率,差异均有极显著性(P<0.01);而在有输卵管手术史的144例患者中,两组对术后生殖状态的影响差异无显著性(P>0.05)。结论手术途径本身对于输卵管妊娠术后生殖状态的影响次于患者合并的各种不良病史。在无不良病史无输卵管粘连的患者中,腹腔镜手术有利于保护其后的生殖状态。

[Objective] To evaluate fertility after laparotomy or laparoscopy for tubal pregnancy. [Methods] A retrospective study was performed. 424 patients with tubal pregnancy underwent surgical treatment from Jan 1999 to Jan 2004. The patients were divided into two groups according laparoscopy or laparotomy, who were followed up for fertlity for a period of 18-72 months. The Chi-square criterion was performed to determine the difference of fertility between two groups. [Results] Among the subgroup of patients with no history and no tubal adhesion, the fertility after laparoscopic treatment was superior to laparotomy. The difference was significant （P 〈0.01）. But among the patients with previous history of tubal surgery, the fertility was equivalent between the two groups （P 〉0.05）. [ Conclusion] In the case of influencing fertility, the pathway of surgery is next to the harmful histories of tube. Laparoscopy is superior to laparotomy at preserving fertility especially in the patients with no history and no tubal adhesion.