药物、传统开腹及腹腔镜手术治疗输卵管壶腹部妊娠的临床对比研究

Comparative Clinical Study on Drugs,Traditional Laparotomy and Laparoscopic Surgery for Tubal Ampulla Pregnancy

目的探讨药物、传统开腹以及腹腔镜手术治疗输卵管壶腹部妊娠的临床应用价值。方法将渭南市中心医院2011年1月至2012年12月收治的209例输卵管壶腹部妊娠患者依据随机数字表法分为三组:药物治疗组(65例)、传统开腹手术治疗组(67例)、腹腔镜手术治疗组(77例)。首先对两组手术患者的手术时间、术中出血量、术后排气时间、离床活动时间、术后药物应用情况、术后病率以及平均住院时间进行比较,选择其中损伤小、恢复快的手术方式与药物治疗组患者的住院时间、治疗成功率、β人绒毛膜促性腺激素(β-HCG)转阴时间、持续性宫外孕发生情况进行比较。结果腹腔镜手术治疗组患者术中出血量、术后排气时间、离床活动时间、住院时间均显著少于传统开腹手术治疗组(P<0.05),术后药物止痛率、术后病率均显著低于传统开腹手术治疗组(P<0.05),半年受孕率显著高于传统开腹手术治疗组(P<0.05);腹腔镜手术治疗组患者住院时间、β-HCG转阴时间均显著少于药物治疗组(P<0.05),治疗成功率、半年受孕率显著高于药物治疗组(P<0.05),持续宫外孕发生率显著低于药物治疗组(P<0.05)。结论对输卵管壶腹部妊娠患者进行治疗,在条件允许的情况下,腹腔镜手术具有损伤小、效果可靠的优点,可以作为首选治疗方式。

Objective To investigate the clinical application value of drugs,traditional laparotomy and laparoscopic surgery for tubal ampulla pregnancy.Methods From Weinan Central Hospital during January 2011 and December 2012,209 cases of tubal ampulla pregnancy were randomly divided into three groups,65 cases of drug treatment group,67 case of the traditional open abdominal surgical treatment group,77 cases of laparoscopic surgery group.Operative time,blood loss,postoperative discharge time,out of bed time,the postoperative drug application,postoperative morbidity,and average length of stay statistics of the two groups were compared,and then the group with less damage and faster recovery were compared with drug treatment group by hospital stay time,the treatment success rate,beta-HCG clearance time,and persistent ectopic pregnancy.Results Blood loss,postoperative exhaust time,ambulation time hospitalization time of laparoscopic surgery group were significantly less than traditional open surgery group（P 0.05）,rate of postoperative medication for pain,postoperative morbidity rate were significantly lower than traditional open surgery group（P 0.05）,the pregnancy rate within half a year was significantly higher than the traditional open surgery group（P 0.05）;hospitalization,β-HCG clearance time of laparoscopic surgery group were significantly less than drug treatment group（P 0.05）,treatment success rate,pregnancy within half a year rate were significantly higher than drug treatment group（P 0.05）,incidence of continuing ectopic pregnancy was significantly lower than the drug treatment group（P 0.05）.Conclusion If conditions allow,laparoscopic surgery has advantages of less damage and reliable effect for fallopian tube ampulla pregnant patients,which can be the first choice for the treatment.