输卵管妊娠手术与药物保守治疗的近期效果观察

The Short Observation of Tubal Pregnancy by Operation and Drug Conservative Therapy

目的:探讨输卵管妊娠手术与药物保守治疗后对输卵管再通的近期影响。方法:回顾性分析2007年4月-2010年4月笔者所在医院收治的112例有保留生育功能意愿且具备药物及手术保守治疗和随访条件治疗成功的输卵管妊娠患者的临床资料。根据治疗方法分为两组,A组54例,行腹腔镜下患侧输卵管保守手术;B组58例,行药物保守治疗。3个月后比较两组患侧输卵管的再通情况,并随访近期(12个月内)宫内妊娠率、重复性异位妊娠率情况。结果:A组54例,术后3个月B超监测下通液,43例通畅,通畅率79.63%;B组58例,术后3个月B超监测下通液,37例通畅,通畅率63.79%。近期(12个月内)宫内妊娠率、重复性异位妊娠率情况:A组54例,实访42例,宫内妊娠29例,占69.05%,重复性异位妊娠6例,占14.29%;B组58例,实访44例,宫内妊娠18例,占40.91%,重复性异位妊娠12例,占27.27%。结论:腹腔镜下输卵管妊娠保守手术,可以有效保留患者生育功能,术后患侧输卵管通畅率、宫内妊娠率明显高于药物治疗者,而重复性异位妊娠率降低,应作为尚未生育或还有生育要求的患者的首选治疗方法。

Objective：To investigate the use of conservative operations of oviductal pregnancy under laparoscope and therapy by methotrexate（MTX）.Methods：112 cases of oviductal pregnancy were cured from Apr 2007 to Apr 2010 were retrospectively studied.In group A,there were 54 cases operated with conservative operations as well as injection of MTX in mesosalpinx.In group B,58 cases MTX were injected only for therapy.The openness of affected oviduct was examined 3 months postoperatively.And intrauterine gestation rate and repeated ectopic gestation rate were followed up in one year.Results：In group A,after 3 months,under B ultrasound and using flush water method,oviduct openness was found in 43 cases,openness rate 79.63%.In group B,after 3 months,oviduct openness was found in 37 cases,with openness rate 63.79%.42 of 54 in group A were followed up in the next year.29 cases experienced intrauterine gestation（69.05%）,while 6 case experienced repeated ectopic gestation（14.29%）.44 cases in group B were followed up in the next year.18 of them experienced intrauterine gestation（40.91%）,while 12 of them experienced repeated ectopic gestation（27.27%）.Conclusion：The openness rate and intrauterine gestation rate are obviously higher after conservative operations of oviductal pregnancy,while the repeated ectopic gestation rate is much lower than therapy by MTX only,which means a maximal breeding ability reservation.So it is suitable for women who have not yet bear any children but wish to do so.