腹腔镜下黄体剥出预防输卵管妊娠保守手术后持续性异位妊娠的观察

Observation of the effect of stripping corpus luteum in the conservative laparoscopic surgery for fallopian pregnancy on prevention of persistent ectopic pregnancy.

目的分析腹腔镜下输卵管保守手术同时妊娠黄体剥出预防持续性输卵管妊娠的意义。方法回顾性分析我院2005年2月至2008年8月对诊断为输卵管妊娠82例患者（其中6例为第2次输卵管妊娠），在腹腔镜下行输卵管保守手术（71例行输卵管切开取胚术，11例行输卵管壶腹部胚囊挤压术），术中均剥除妊娠黄体，观察手术前后患者血清人绒毛膜促性腺激素（β-HCG）和孕酮值变化并随访手术后持续性输卵管妊娠发生情况。结果所有病例均在腹腔镜下顺利完成手术，黄体剥出手术时间5～10min，手术后血清β-HCG[（1213．51±118．84）U／L]和孕酮值[（3．25±2．44）nmol／L]均较手术前[分别为（4267．86±983．56）U／L、（13．71±6．24）nmol／L]显著下降（P均〈0．01），血清β—HCG与孕酮水平显著相关（r=0．697，P〈0．05），术后仅有1例发生持续性输卵管妊娠；术后3个月45例行子宫输卵管碘油造影显示患侧输卵管通畅32例，通畅率71．1％（32／45），7例患侧输卵管阻塞，阻塞率为15．6％（7／45）。术后1年发生患侧输卵管再次异位妊娠2例。结论输卵管妊娠腹腔镜下保守手术时黄体剥出对有生育要求的患者是一种安全有效的手术方式，有预防持续性输卵管妊娠的意义。

Objective To understand the clinical effect of conservative laparoscopic surgery with stripping corpus luteum for fallopian pregnancy to prevent persistent ectopic pregnancy. Methods From January 2005 to August 2008,82 cases of fallopian pregnancy （6 cases for the second time） were performed conservative operation through laparoscopic surgery with stripping corpus luteum. Seventy one cases underwent salpingostomy to remove the embryo, and other 11 cases were performed with extrusion of embryo sac at ampulla. The level of serum progesterone, β-HCG were measured before and after the therapy. All patients were followed up for one year. Results All patients＇ surgery had been successfully done through laparoscopic surgery. The duration of stripping corpus luteum was 5 to 10 minutes. The serum β-HCG（ Mean ± SD ： （ 1213.51 ± 118.84） U/L） and progesterone （ Mean ± SD ： （ 3.25 ± 2.44） nmol/L） after operation were significantly lower than before the therapy （ Mean ± SD ： （ 4267.86 ± 983.56 ） U/L, （13.71 ± 6.24）nmol/L,respectively） （P 〈0.01 ）. The decrease of β-HCG value was significantly correlated with the decreasing of progesterone （r = 0. 697,P 〈 0.05 ）. Only one patient had a persistent ectopic pregnancy. Fallopian examination through hysterosalpingography after 3 months was unobstructed in 71.1% （32/45 cases） and obstructed in 7 cases （ 15.6 % ）. After one year of the therapy two patients had ectopie pregnancy at the same fallopian tube. Conclusions For females who have reproductive requirements with experience of fallopian pregnancy, conservative operation through laparoseopic surgery with stripping corpus luteum is safe and effective, and might have an important clinical effect to prevent postoperative persistent ectopic pregnancy.