输卵管妊娠腹腔镜手术与药物保守治疗效果的比较

Comparison of therapeutic effect of conservative laparoscopic operation and conservative chemotherapy for tubal pregnancy

目的 比较输卵管妊娠腹腔镜保守手术治疗和化学药物保守治疗的近期、远期效果.方法 131例有生育要求的输卵管妊娠病例,分腹腔镜保守手术（A组）73例、化学药物保守治疗（B组）58例,分别观察其治疗成功率、住院天数、出院时血β-hCG值,治疗后输卵管通畅率、宫内妊娠率、再次异位妊娠率.结果 相对于化学药物保守治疗,腹腔镜保守手术治疗成功率高（P〈0.01）、住院天数短（P〈0.01）、血β-hCG值下降快（P〈0.01）、输卵管通畅率和再次宫内妊娠率高（P〈0.01）;再次异位妊娠率比较无显著差异（P〉0.05）.结论 对年轻有生育要求的输卵管妊娠患者进行治疗,腹腔镜保守手术有疗效快、住院时间短、恢复快、输卵管通畅率和宫内妊娠率高的优势,值得应用.

Objective To compare short-term and long-term therapeutic effects of conservative laparoscopic oviduct-sparing and conservative chemotherapy for tubal pregnancy. Methods A total of 131 patients with tubal pregnancy who had continous pregnancy desires were divided into two groups ： 73 pregnant women with tubal pregnancy in laparoscopic operation group （ group A） were performed on conservative laparoscopic oviduct-sparing operation and 58 pregnant women with tubal pregnancy in conservative chemotherapy group （group B） were given chemotherapy. The treatment success rate, hospitalization length （days）, serum level of β-hCG at discharge, oviduct patency rate after treatment and incidence rates of intrauterine pregnancy and recurrent tubal pregnancy in the two groups were compared. Results As compared with group B, the treatment success rate in group A was higher （ P 〈 0.01 ）, hospitalization length was shorter （P 〈0.01 ）, decrease in serum level of β-hCG at discharge day was sharp （P 〈0.01 ）, the oviduct patency rate and intrauterine pregnancy rate were higher （ both P 〈 0.01 ）. While in recurrent tubal pregnancy rate there was no statistically significant difference between group A and group B （ P 〉 0. 05 ）. Conclusion For those young pregnant women with tubal pregnancy who have continous pregnancy desires, conservative laparotcopic oviduct-sparing operation for tubal pregnancy has some advantages such as rapid initiation of therapeutic effect, shorter hospital stay, rapid recovery and higher oviduct patency rate and intrauterine pregnancy rate, so it is worthy to be applied in clinic.