输卵管妊娠腹腔镜保守性手术后早期通液治疗的价值

Value of early hydrotubation for the patients with tubal pregnancy after laparoscopic conservative surgery

目的:探讨输卵管妊娠腹腔镜保守性手术后早期通液治疗对患侧输卵管的通畅率、术后宫内妊娠率、重复性异位妊娠率的影响。方法:前瞻性研究110例有生育要求行腹腔镜保守性手术的输卵管妊娠患者,随机分为A、B两组。A组(n=68例)术后首次月经干净即行输卵管通液治疗。B组(n=42例)术后首次月经后未行通液治疗。所有病例均于术后3～4个月行输卵管碘油造影检查(HSG),并随访术后1～2年的再次妊娠情况。结果:患侧输卵管通畅率A组85.29%,B组66.67%,差异有统计学意义(P<0.05);宫内妊娠率A组86.76%,B组71.43%,差异有统计学意义(P<0.05);其中患侧输卵管通畅者宫内妊娠率A组83.82%,B组57.43%,差异具有统计学意义(P<0.01);重复性异位妊娠率A组1.47%,B组2.38%。结论:术后早期的输卵管通液治疗有助于提高患侧输卵管的通畅率及术后的宫内妊娠率,降低重复性异位妊娠的发生。

Objective：To explore the effect of early hydrotubation after laparoscopic conservative surgery on patency rate of fallopian tubes of affected side,postoperative intrauterine pregnancy rate,and recurrent ectopic pregnancy rate among the patients with tubal pregnancy.Methods：One hundred and ten patients with tubal pregnancy who had birth demand and received laparoscopic conservative surgery were selected and divided into group A and group B randomly.Sixty-eight patients in group A were treated with hydrotubation after the first menstruation.Forty-two patients in group B didn＇t receive hydrotubation after the first menstruation.All the patients received hysterosalpingography at 3-4 months after operation,the secondary pregnancy situations were followed up at 1-2 months after operation.Results：The patency rates of fallopian tubes of affected side in group A and group B were 85.29% and 66.67%,respectively,there was significant difference（P0.05）.The intrauterine pregnancy rates in group A and group B were 86.76% and 71.43%,respectively,there was significant difference（P0.05）.Among the patients with patent fallopian tubes of affected side,the intrauterine pregnancy rates in group A and group B were 83.82%and 57.43%,respectively,there was significant difference（P0.01）;the recurrent ectopic pregnancy rates in group A and group B were 1.47% and 2.38%,respectively.Conclusion：Early hydrotubation after laparoscopic conservative surgery is helpful to improve the patency rate of fallopian tubes of affected side and intrauterine pregnancy rate after operation,and reduce the occurrence of recurrent ectopic pregnancy among the patients with tubal pregnancy.