内缝合技术联合MTX局部注射在腹腔镜下输卵管妊娠切开取胚术中的应用

The value about the intro-suturation by LSC union part-enchysis with MTX in the technique of blasto-discissio of tubal pregnancy by LSC

目的:探讨内缝合技术联合MTX局部注射在腹腔镜下输卵管妊娠切开取胚术中的应用价值。方法:60例要求保留输卵管的患者经腹腔镜下切开取胚术后,利用内缝合技术缝合输卵管浆肌层,恢复输卵管解剖生理结构,输卵管系膜注射MTX。结果:60例患者均顺利完成手术,无中转开腹手术。60例术后病理证实输卵管妊娠;术后平均10～14d血HCG转阴,术后1月复查B超未见附件区包块;37(61.7%)例术后3月子宫输卵管造影(HSG)提示患侧输卵管通畅,无输卵管瘘发生,13(21.7%)例不通;21(35.0%)例术后1年自然受孕,包括1例单侧输卵管患者。结论:内缝合技术联合MTX局部注射在腹腔镜下输卵管妊娠切开取胚术中的应用避免了输卵管瘘的形成,减少术中出血,可很好预防术后持续性异位妊娠(PEP)的发生。对年轻有生育要求者保留生育功能有积极意义。

Objective：To study the technique of intro-suturation by LSC union part-enchysis with MTX that used in the technique of blasto-discissio by LSG to curat tubal pregnancy. Methods：Retrospective analysis of 60 cases of tubal pregnancy , who asked remain the oviduck , we had intro-suturat serosa and muscularcoat of oviduck by LSC after blasto-discissio by LSC union enchysis with MTX in mesosalpinx to remain the architectonic and use of oviduck. Results ：The operation was performed on 60 case with LSC ,TP was certificated by pathology . HCG darkening within 10-14 days average,and there had no mas in appendant when they rechecked with ultra-B after 1 month. 37 case＇ s ovarian duct to be unobstructed proofed by hysterosalpinggraphy after 3 month; 13 case＇ s ovarian duct were obstructed; 21 case had pregnancy natural （Including one case of TP）. Conclusion ：Operation by LSC can be as the same effect as operation by open abdom ,it can recover the integrality of anatomic struct and physiological functions of organ. This technique has active significance to young patient of tubal pregnance who wants to remain function of procreation of oviduek.