输卵管妊娠腹腔镜下不同手术方式的比较

A comparison of therapeutic effects of two laparoscopic operation methods for tubal pregnancy

目的了解腹腔镜手术治疗输卵管妊娠中保守性手术与输卵管切除两种术式的效果。方法502例腹腔镜下治疗输卵管妊娠中，行输卵管切除术组136例，行保守性手术治疗组366例。对两组的手术时间、出血量、血人绒毛膜促性腺激素定量恢复正常时间、术后并发症以及平均住院时间进行比较。结果腹腔镜手术治疗输卵管妊娠中行输卵管保守性治疗与行输卵管切除术的手术时间分别为57．7±22．2分钟、55．8±15．3分钟（t=1．73），出血量分别为31．7±15．7mL、32．8±16．4mL（t=1．64），血人绒毛膜促性腺激素定量恢复正常时间分别为18．1±2．1天、16．8±3．2天（t=1．18），术后发生持续性异位妊娠几率（6、0）以及平均住院时间（6．1、5.9天）（t=0．96）经比较均无显著性差异（P〉0．05）。结论腹腔镜治疗输卵管妊娠中行输卵管保守性治疗与行榆卵管切除术能达到同样的治疗效果，行输卵管保守性手术可最大限度地保护卵巢的功能。因此，输卵管妊娠行腹腔镜手术时宜选择保守性手术方式治疗。

Objective To compare therapeutic effects of two laparoscopic operations--laparoscopic salpingectomy and laparoseopic conservative operation （ oviduct-sparing operation ） for tubal pregnancy. Methods The operation records and clinial data of 502 women with tubal pregnancy who underwent laparoscopic operation （136 women received laparoscopic salpingectomy and 366 women received laparoscopic conservative operation） were reviewed. The operation time, intraoperative blood loss, recovery time of serum hCG level, postoperative complications and mean hospital stay after operation of the patients in both laparoscopic oviduct-sparing operation group and laparoscopic salpingectomy group were compared. Results There were no significant differences found between laparoscopic oviduct-sparing operation group and laparoscopic salpingectomy group in operation time （57.7 ±22.2min vs 55.8 ± 15.3 min, t = 1.73, P 〉0.05 ）, intraoperative blood loss （31.7 ± 15.7mL vs 32.8 ± 16.4mL, t = 1.64, P 〉 0. 05）, recovery time of serum hCG level after operation（ 18.1 ± 2. 1d vs 16.8 ±3.2d, t = 1.18, P 〉 0.05 ）, incidence rate of postoperative persistent ectopic pregnancy （PEP） （6 vs 0） and mean hospital stay （ 6. 1d vs 5.9d, t = 0. 96, P 〉 0. 05. Conclusion The therapeutic effects of laparoscopic oviduct-sparing operation and laparoscopic salpingectomy for tubal pregnancy are same. However, the laparoscopic oviduct-sparing operation could preserve function of the ovary as possible. Accordinly, the laparoscopic oviduct-sparing operation should be chosen firstly in treatment of tubal pregnancy.