重复输卵管妊娠保守手术后输卵管功能研究

Tubal function after conservative surgery of repeated tubal pregnancy

目的探讨腹腔镜下输卵管妊娠保守手术术后对输卵管功能进行量化评估的意义。方法对2006年1月～2008年12月一侧输卵管已切除的重复输卵管妊娠的28例患者进行前瞻性研究。所有患者均行腹腔镜下输卵管妊娠保守手术,术后行宫腔镜下输卵管插管通液术,同时通过输卵管通液仪测定输卵管压力,并随访术后1年妊娠率。结果不同部位输卵管妊娠保守手术术后患侧输卵管压力差异有显著性,壶腹部妊娠为(15.4±4.5)kPa,峡部妊娠为(22.7±3.5)kPa。术后宫内妊娠率与输卵管压力相关,输卵管内压力小于15kPa术后宫内妊娠率与输卵管压力16～20kPa组比较差异无显著性,输卵管内压力大于21kPa组明显低于压力小于20kPa组。壶腹部妊娠和峡部妊娠术后宫内妊娠率比较差异有显著性。结论输卵管妊娠保守手术后输卵管功能恢复与输卵管妊娠部位有关;宫内妊娠率与输卵管压力相关;宫腔镜下输卵管插管通液结合输卵管通液仪能有效判断输卵管妊娠保守手术术后输卵管的通畅情况,并能对其进行量化分析,预测宫内妊娠几率,为指导受孕方式提供重要信息。

[Objective]To analysis the significance of quantitative assessment of tubal function after laparoscopic tubal pregnancy conservative surgery. [Methods]28 cases after conservative surgery of repeated tubal pregnancy and the other side salpingectomy from January 2006 through December 2008 were carried out prospectively. All patients underwent laparoscopic tubal pregnancy conservative surgery, and tubal catheterization and hydrotubation using hys-teroscopy postoperatively. Hydrotubation tubal pressure was measured at the same time. The rates of pregnancy were observed. [Results]A significant difference was found in the tubal pressure [（15.4±4.5） vs. （22.7±3.5） kPa] between ampulla pregnancy and isthmus pregnancy after conservative surgery. The rate of intrauterine pregnancy was related to the tube pressure. There was no statistical difference in intrauterine pregnancy rate between group of pressure less than 15 kPa and pressure of 16 ～ 20 kPa. The pregnancy rate of pressure greater than 21 kPa was significantly lower than the pressure less than 20 kPa. There was significant statistical difference in pregnancy rate after ampulla and isthmus preg-nancy. [Conclusion]The recovery of tubal function after conservative surgery of tubal pregnancy was site-related. The rate of intrauterine pregnancy was pressure-related. Tubal patency can be determined effectively and quantitatively by tubal catheterization and hydrotubation using hysteroscopy combining with pressure measurement. Intrauterine pregnancy rate can be predicted. Important information to guide pregnancy can also be provided.