腹腔镜诊治早期不典型输卵管妊娠临床分析

Clinical Analysis on Laparoscopic Diagnosis and Treatment of Early Atypical Tubal Pregnancy

目的探讨腹腔镜对早期不典型输卵管妊娠的诊疗价值。方法38例均因早期或不典型输卵管妊娠行腹腔镜手术。明确看到输卵管有蓝紫色妊娠物或发现一侧输卵管局部略增粗并呈紫色而未见明显妊娠肿物,均行输卵管切开取胎术+输卵管缝合修补术。双侧输卵管外观均未见任何异常者,暂无生育要求,则先行诊断性刮宫,确诊输卵管妊娠后,于双侧输卵管壶腹部各注入甲氨蝶呤(MTX)30mg;有生育要求则不行诊断性刮宫。结果术前误诊5例,误诊率13%。腹腔镜误诊3例,误诊率8%。腹腔镜下输卵管切开取胎术+输卵管缝合修补术30例,输卵管注射MTX保守治疗4例,均成功,术后血β-hCG降至正常时间(4.2±3.1)d。结论腹腔镜是早期不典型输卵管妊娠诊治的最佳选择。

Objective To explore the diagnostic and therapeutic effects of laparoscopy for early atypical tubal pregnancy. Methods Laparoscopy was conducted for diagnosing and treating 38 cases of early or atypical tubal pregnancy. For patients with blue and purple pregnant swellings seen clearly in the fallopian tubes, or those with one side of fallopian tube locally swollen and purple without obvious pregnant swellings observed, combination of fallopian tubes incision to take out embryo and salpingorrhaphy was performed. For those cases with normal fallopian tubes on both sides in appearance and without current desire of pregnancy, diagnostic uterine curettage was applied. After the diagnosis of tubal pregnancy was confirmed, 30 mg of MTX was injected into ampulla of both sides. For patients with demand of reproduction, diagnostic uterine curettage was not performed. Results Five cases were misdiagnosed before operation, the misdiagnosis rate was 13% . Three cases were misdiagnosed by laparoscopy, and the rate was 8%. Fallopian tubes incision for embryo-taking under laparoscope combined with salpingorrhaphy were applied to 30 cases. Four cases were treated conservatively with injecting 30 mg of MTX into the fallopian tubes. The success rate was 100%. Blood β-hCG was back to the normal level （4.2：1：3.1） days after surgery. Conclusions Laparoscopy is the optimal technique for the diagnosis and treatment of early atypical tubal pregnancy.