腹腔镜下采用不同术式治疗输卵管妊娠后的生殖状态

Study on reproductive outcome of different laparoscopic procedures for ectopic pregnancy

目的比较腹腔镜下不同手术方式治疗输卵管妊娠后,宫内妊娠率和再次异位妊娠的风险差别。方法回顾分析118例输卵管妊娠行腹腔镜手术治疗且希望保留生育能力并有随诊条件的患者的临床资料,根据手术方式不同进行分组;A组行患侧输卵管开窗取胚术同时加患侧输卵管近端注射甲氨蝶呤(MTX)30mg的保留输卵管手术,共62例;B组在无法保留患侧输卵管或已有一子女,对侧卵管外观正常时行输卵管切除术,共56例。比较两组不同手术方式治疗输卵管妊娠后的生殖状态。结果术后1～3年宫内妊娠率:A组[19例(30.6%)]与B组[16例(28.6%)]比较无显著性差异(P﹥0.05);异位妊娠发生率:A组[11例(17.7%)]与B组[3例(5.3%)]比较有显著性差异(P﹤0.05)。结论输卵管妊娠行腹腔镜下保留患侧输卵管手术应慎用,宫内妊娠率虽然略高于切除者,但可增加再次宫外孕发生的危险。

Objective To investigate the reproductive outcome of different laparoscope operations of ectopic pregnancy. Methods 118 ectopic pregnant patients wished to keep reproductive ability and were followed up after laparoscope operations. They were divided into two groups by different types of procedure under laparoscope. Group A （n=62） were performed with laparoscopic fallopian tube reformation. Group B （n=56） were performed with laparoscopic fallopian tube ectomy. The reproductive outcome after laparoscope was investigated. Results Intrauterine pregnancy rate and the second ectopic pregnancy rate after laparoscope within 1 to 3 years of two groups were compared. Intrauterine pregnancy rate was 30.6% and 28.6% respectively. There was no significant difference in both groups （P 〉 0.05）. The second ectopic pregnancy rate was 17.7% and 5.3% respectively. The difference was significant （ P 〈 0.05）. Conclusions The repregnancy rate of fallopian tube reformation patients is not evidently lower than fallopian tube ectomy patients. But the second ectopic pregnancy rate increases remarkably.