输卵管妊娠治疗后宫腔镜输卵管插管的价值

Therapeutic value of hysteroscopic tubal catheterization liquid instillation treatment following conservative management of tubal pregnancy

目的通过分析宫腔镜输卵管插管通液术在输卵管妊娠保守治疗后的应用价值，探讨选择更好的治疗方案及提高宫内妊娠率的方法。方法对2004年10月至2006年10月在江阴市人民医院住院且有生育要求的70例患者进行随访。输卵管妊娠患者保守治疗成功后2～6个月行宫腔镜输卵管插管通液组35例为观察组，行输卵管通液组35例为对照组，对其治疗效果进行分析。结果①观察组宫内妊娠率为48、5％，复发性异住妊娠率为14．2％；对照组宫内妊娠率为25．7％，复发性异位妊娠率22．9％。两组宫内妊娠率比较有显著性差异（X^2=9．67，P〈0．05），复发性异位妊娠率比较无显著性差异（X^2=2．20，P〉0．05）；②观察组双侧输卵管通畅宫内妊娠率为75．0％，一侧输卵管通畅宫内妊娠率34、8％，二者比较有显著性差异（X^2=5．11，P〈0．05）。结论输卵管妊娠保守治疗后输卵管的功能取决于其通畅情况，通过宫腔镜输卵管插管通液可有效地判断输卵管通畅情况，且能够提高宫内妊娠率，但不能减少重复异位妊娠率。

Objective To investigate application value of hysteroscopic tubal catheterization liquid instillation treatment following conservative management and reproductive status of women with tubal pregnancy. Methods 70 women with tubal pregnancy admitted to Jiangin Municipal People＇ s Hospital over a period from October 2004 to October 2006 who desired childbearing were selected. 35 women with tubal pregnancy received hysteroscopic tubal catheterization liquid instillation treatment （as observation group）at 2 -6 months after conservative management and other 35 women with tubal pregnancy received routine tubal patent treatment by liquid instillation （as control group） after conservative management at same time. The therapeutic effects in the two groups were observed and compared. Results ① Of 35 women with tubal pregnancy in the observation group, 17 women （48.5%） had a intrauterine pregnancy, 5 women （14.2%） had a recurrent tubal pregnancy, and 13 women （37.1%） had no pregnancy. Of other 35 women with tubal pregnancy in the control group, 9 women （25.7%） had a intrauterine pregnancy, 8 women （22.9%） had a recurrent tubal pregnancy, and 18 women （51.4%） had no pregnancy. Significant difference was found in intrauterine pregnancy rate between the two groups （X^2 = 9.67, P 〈 0.05 ）. While in recurrent tubal pregnancy no significant difference was found between the two groups （X^2 = 2.20, P 〉 0.05 ） ② In intrauterine pregnancy rate between patent two lateral tubes subgroup （75.0%） and patent one lateral tube subgroup （34.8%）, there was a significant difference （X^2 = 5.11, P 〈0.05 ）. Conclusion The intrauterine pregnancy rate after conservative management of tubal pregnancy depends on tubal patent extent. Wile hysteroscopic tubal catheterization liquid instillation treatment after conservative management of tubal pregnancy can judge patent status for the tubes and improve intrauterine pregnancy rate, but it can not decrease recurrent tubal pregnancy rate.