垂体后叶素在腹腔镜输卵管间质部妊娠切开取胚术中的应用

Application of Hypophysin in Laparoscopic OpeningTaking Embryo Operation on Interstitial Tubal Pregnancy

目的:探讨垂体后叶素用于腹腔镜下输卵管间质部妊娠切开取胚术的安全性和可行性。方法:选择2005年1月至2011年1月,在我科术前诊断包块型输卵管间质部妊娠,要求保留生育功能的患者62例,按手术时间分为研究组40例,对照组26例,两组患者均行腹腔镜下输卵管间质部妊娠切开取胚术,研究组术中于妊娠包块表面、远端及子宫角、输卵管系膜4点注射垂体后叶素,水压分离法剥离妊娠囊;对照组术中不用垂体后叶素。比较两组手术成功率、手术时间、术中出血量、术后持续性异位妊娠(PEP)发生率、术后输卵管通畅情况及术后随访情况。结果:研究组手术成功率(95%)明显高于对照组(77%)(P<0.01)。研究组手术时间(48.6±11.2分钟)显著短于对照组(77.5±12.4分钟)(P<0.01);研究组术中出血量(26.7±10.4ml)显著少于对照组(66.7±14.4ml)(P<0.01);研究组无持续性异位妊娠发生,对照组发生2例(10.5%);研究组术后输卵管通畅率(69.4%)高于对照组(38.9%)(P<0.05)。结论:垂体后叶素"4点"注射法用于腹腔镜下包块型输卵管间质部妊娠切开取胚术是安全、有效的,可用于输卵管间质部妊娠的治疗。

Objective：To explore the safety,feasibility of using hypophysin interstitial tubal pregnancy treated with laparoscopic opening-taking embryo operation. Methods ：The clinical data of 62 cases with lump interstitial tubal pregnancies （ requesting reserve procreate function ） from 2005.01 to 2011.01 were retrospectively analyzed. Among them ,40 patients were in study group and 26 patients were in control group. All patients were treated with opening-taking embryo by laparoscopic operation. In study group,we first injected hypophysin into pregnancy lump,distal end,cornua uteri and mesosalpinx, second striped gestation sac with hydraulic pressure separation during operation ;while in control group,we opened pregnancy lump and taked out pregnancy tissue according to convention method without injecting hypophysin. Operation accomplish rate, operation time, operation blood volume, persistent ectopic pregnancy （PEP） happening rate, fallopian tube unobstructed information and pregnancy information after operation were compared between these two groups. Results：In study group, operation success rate was 95%,was significantly higher than that in control group（77%） （P 〈 0. 01 ）, operation time （48.6 ± 11.2 min） was significantly shorter than that in control group（77. 5 ± 12.4 min） （ P 〈 0.01 ） ;operation blood volume was （26. 7 ± 10.4 ml）, was obviously lesser than that in control group （66.7 ±14. 4 ml） （ P〈0.01 ） ;there was no persistent ectopic pregnancy（PEP） in study group, while there were 2 persistent ectopic pregnances（10.5% ） in control group. Fallopian tube unobstructed rate after operation in study group （69.4%） was higher than that in control group （38.9%） （ P 〈 0.05）. Conclusions.Application of 4 points hypophysin injection in opening-taking embryo by laparoscopic operation on lump interstitial tubal pregnancies is safe and effective, which can be regarded as one of selection in operative treatment on interstitial tubal pregnancy.