不同治疗方法对输卵管妊娠后生育结局与卵巢功能影响的研究

The research of clinical effect on reproductive outcomes and ovarian reserve by different treatment for tubal pregnancy

目的探讨使用不同方法治疗输卵管妊娠后患者的生育结局及其影响因素。方法将238例输卵管妊娠患者分别采用3种治疗方法,A组86例,采用药物甲氨蝶呤(methotrexate,MTX)治疗;B组120例,采用输卵管切除术;C组32例,采用保守手术(保留患侧输卵管)。通过测定治疗后的性激素水平,超声测量卵巢体积、输卵管通畅度及生育结局,比较3组之间生育状况。结果输卵管切除组与其他两组比较,卵泡刺激素(follicle stimulating hormone,FSH),黄体生成素(luteinizing hormone,LH),雌二醇(estradiol,E2)值均显著升高,而卵巢体积及窦卵泡数显著减少,差异有统计学意义(P<0.05)。238例患者中,54例(22.69%)获得宫内妊娠;56例(23.53%)发生重复异位妊娠;128例(53.78%)患者仍然未孕;宫内妊娠率C组37.50%,B组25.00%。重复异位妊娠率C组15.63%,B组25.83%,两组比较差异有统计学意义(P<0.05)。结论输卵管切除术影响卵巢储备功能,有生育要求的患者宜行保守性手术。在影响输卵管妊娠手术治疗后生育结局的因素中,腹腔镜手术明显优于开腹手术,保留输卵管的手术明显优于输卵管切除术。

Objective To investigate the reproductive outcome of different treatments for tubal pregnancy and the influencing factors. Methods All 238 cases of tubal pregnancy were divided into Group A with 86 cases taken by Methotrexate （MTX） ,Group B with 120 cases under the salpingectomy and Group C with 32 cases by conservative surgery for retaining oviduct. The data of ovarian volume, tubal patency and reproductive outcome after different treatments were compared among three groups. Results The levels of follicle stimulating hormone （ FSH）, luteinizing hormone（LH） ,estradiol（ E2 ） in Group B were significantly higher than those in other two groups. While ovarianvolume and the numbers of antral follicle in Group B were significantly less than those in the other two groups. Among 238 cases, 54 patients were intrauterine pregnant （22. 69% ）, 56 patients were repeat ectopic pregnant again （25.55%） and 128 patients were still not pregnant （53.78%）. The rate of intrauterine pregnancy in Group C with 37.50% was much higher than that in Group B with 25.00% （ P 〈 0. 05 ）. Recurrent ectopic pregnancy rate was lower in Group C with 15.63% than that in Group B with 25.83%. Conclusion Salpingectomy affects the ovarian reserve. The reproductive requirements of patients should undergo conservative surgery. During the factors that influencing reproductive outcome after surgical treatment of tubal pregnancy, laparoscopic surgery is obviously better than open surgery, tubal surgery retained significantly better than salpingectomy.