腹腔镜下输卵管开窗后局部加压冲洗取胚44例临床体会

Clinical study of 44 patients with tubal ectopic pregnancy who underwent laparoscopic tubal window wash for taking embryos under local pressurization

目的评价腹腔镜下行保留生育功能的输卵管异位妊娠术的疗效,探讨该术式的技术要点。方法回顾性分析在我院行腹腔镜下保留生育功能的输卵管异位妊娠术78例患者的临床资料,按手术方式不同分为A、B两组,A组34例开窗后采取钳夹及管壁挤压自切口内取出妊娠物的术式,B组44例开窗后采取局部加压冲洗使妊娠物自管壁分离后排出的术式。将两组手术时间、术中出血量、局部创伤情况、术后β-HCG降至正常值的时间及输卵管复通率进行比较。结果 B组患者在手术时间、术中出血量、局部创伤情况及输卵管复通率方面均较A组有显著优势(P<0.05)。结论腹腔镜下输卵管开窗取胚术联合局部注射MTX治疗输卵管妊娠保留生育功能是安全、有效的,其中开窗后采取局部加压冲洗使妊娠物自管壁分离法更可取,值得临床推广应用。

Objective To evaluate the curative effect of laparoscopic operation in the treatment of tubal ectopic pregnancy with reproductive function preserved and explore technical points of this surgical method.Methods Clinical data of 78 patients with tubal ectopic pregnancy who underwent laparoscopic operation with reproductive function preserved were reviewed and analyzed.They were divided into two groups.The 34 patients of Group A underwent the operation in which pregnancy product were removed from the incision by clamps and tube wall extrusion.The 44 patients of Group B underwent laparoscopic tubal window wash for disassociating pregnancy products from the tube wall under local pressurization.The operative time,intraoperative blood loss,local trauma,β-HCG dropped to the normal value after the surgery and the rate of the fallopian tube recanalization of the two groups were compared.Results Group B had remarkable superiority in terms of operative time,intraoperative blood loss,local trauma and the rate of the fallopian tube recanalization（P0.05）.Conclusion Laparoscopic tubal window taking embryos with injecting MTX in the treatment of tubal pregnancy is safe and effective for fertility preserving.And laparoscopic tubal window wash for disassociating pregnancy products from the tube wall under local pressurization is preferable.It is worth clinically applying and popularizing.