腹腔镜下行保留生育功能的异位妊娠保守治疗临床效果研究

Study on clinical efficacy of laparoscopic surgery in conservative treatment of ectopic pregnancy

目的:探讨腹腔镜下行保留生育功能的异位妊娠保守治疗临床效果。方法:回顾性分析132例异位妊娠患者,根据接受的手术方案不同分为腹腔镜开窗取胚联合甲氨蝶呤(MTX)注射组(A组52例)、单纯腹腔镜开窗取胚组(B组50例)、单纯MTX注射组(C组30例),观察3组患者治疗前后血β-HCG水平、附件包块大小变化、住院时间、术后输卵管通畅情况,再次宫内妊娠率以及再次同侧异位妊娠的情况。结果:A、B、C组住院时间分别为(5.2±2)、(7.8±3)、(10.3±2)天,术后β-HCG降至正常平均时间分别为(9.6±8)、(14.9±7)、(21.7±7)天,附件包块消失的平均时间分别为(4.4±5)、(9.1±5)、(13.2±6)天;A组各项均优于B和C组,差异有统计学意义(P<0.05)。3组患者术后输卵管通畅率分别为94.6%、80.1%、75.3%,A组患者明显优于其他两组,差异有统计学意义(P<0.01)。术后3组患者的受孕率分别为79.2%、73.5%和65.1%,宫内妊娠率分别为59.4%、50.8%和41.7%。结论:腹腔镜开窗取胚联合MTX注射治疗异位妊娠住院时间短、疗效确切、远期并发症少、再次妊娠率高,应为具有保留生育功能的异位妊娠患者的首选治疗方案,值得在临床推广应用。

Objective： To explore the clinical efficacy of laparoscopic surgery in conservative treatment of ectopic pregnancy. Methods： A total of 132 patients with ectopic pregnancy were analyzed retrospectively, then they were divided into group A （including 52 patients treated with laparoscopic surgery combined with methotrexate injection） , group B （including 50 patients treated with simple laparo- scopic surgery）, and group C （including 30 patients treated with simple injection of methutrexate） according to surgical plans; the blood β- human chorionic gonadotropin （ β - HCG） levels before and after treatment, the changes of sizes of adnexal masses, hospitalization times, postoperative tubal patency rates, subsequent intrauterine pregnancy rates, and subsequent homolateral ectopie pregnancy in the three groups were observed. Results： The hospitalization times in group A, group B, and group C were （5.2 ± 2） days, （7.8 ± 3） days, and （ 10. 3 ± 2） days, respectively; the times of blood β - HCG levels return to normal after treatment in group A, group B, amt group C were （9. 6 ±8） days, （14. 9 ±7） days, and （21.7 ±7） days; the mean disappearance times of adnexal masses in group A, group B, and group C were （4. 4 ± 5） days, （9. 1 ± 5） days, and （ 13.2 ± 6） days, respectively; the indexes above - mentioned in group A were statistically significantly better than those in group B and group C, （P 〈 0. 05） . The tubal patency rates in group A, group B, and group C were 94. 6% , 80. 1% , and 75.3% , respectively, the tubal patency rate in group A was statistically significantly higher than those in the other two groups （P 〈0. 01 ） . The fertilization rates in group A, group B, and group C after treatment were 79. 2% , 73.5% , and 65. 1% , respectively, and the intrauterine pregnancy rates in the three groups were 59.4% , 50. 8% , and 41.7% , respectively. Conclusion： Laparo- scopic surgery combined with methotrexate for treatment of ectupic pregnancy has the advantages of short hospitalization time, good curative effect, less long - term complications, and high subsequent pregnancy rate, which should be adopted as the prefcrred therapeutic schedule for patients with ectopic pregnancy who want to preserve reproductive function, and the method is worthy to be popularized and applied in clinic.