输卵管间质部妊娠腹腔镜下病灶切开缝合与楔形切除的比较研究

Comparison between Incision Suturing and Wedge Resection by Laparoscopy for Interstitial Tubal Pregnancy

目的探讨腹腔镜下输卵管间质部切开缝合术治疗输卵管间质部妊娠的临床应用价值。方法 2007年1月～2012年6月,对间质部妊娠21例,根据患者的生育要求及术前血β-hCG情况选择手术方式。病灶楔形切除组9例,在腹腔镜下楔形切除病灶,可吸收线连续缝合切口;切开缝合组12例,在腹腔镜下切开病灶隆起部位,吸出孕囊及附属组织,可吸收线连续缝合切口。观察术中出血量及手术时间,术后β-hCG下降情况,术中亚甲蓝通液、术后碘油造影了解患侧输卵管通畅情况。结果 2组手术时间、术中出血量、术前术后Hb差值差异均无显著性(P>0.05)。2组术后第21～28天血β-hCG均降至正常。切开缝合组患侧输卵管再通率术中为75%(9/12),术后2个月为58%(7/12)。2组均无并发症发生。结论间质部妊娠行腹腔镜病灶切开缝合术可部分保留输卵管的通畅性。

Objective To evaluate laparoscopic incision suturing for the treatment of interstitial tubal pregnancy. Methods From January 2007 to June 2012, 21 patients with interstitial tubal pregnancy were enrolled into this study. Based on the demand of the patients and the preoperative serum level of 3-hCG, we performed wedge resection （9 cases, with continuous suturing with absorbable sutures） or incision suturing （12 cases） with laparoscopy.In the incision suturing group, we cut the lesion under a laparoscope to remove the fertilized egg and attached tissues, and then closed the incision by continuous suturing with absorbable sutures. Intraoperative blood loss, operation time anti postoperative decrease of 3-hCG level were recorded, and the patency of the fallopian tube were tested with methylene blue during the operation and then hysterosalpingography postoperatively. Results No significant difi^erence was detected between the two groups in operation time, intraoperative blood loss, and pre- and postoperative serum levels of Hb （ P 〉 0.05 ）. In both the groups, the level of ^-hCG decreased to a normal level in 21 to 28 days after the surgery. In the incision suturing group, the rate of reeanalization of the affected fallopian tube was 75% （9/12） during the operation, and then 58% （7/12） in two months after the operation. No complications occurred in neither of the groups. Conclusion With laparoseopic incision suturing, the patency of the affected fallopian tube is secured in patients with interstitial tubal pregnancy.