腹腔镜手术治疗输卵管妊娠206例

Laparoscopic operation on tubal pregnancy in 206 cases

目的探讨腹腔镜手术治疗输卵管妊娠的临床应用。方法对206例异位妊娠患者依据具体情况行腹腔镜下不同手术。术后监测血人绒毛膜促性腺激素（HCG）水平。输卵管妊娠保守性手术术中予以甲氨蝶呤局部注射，术后3个月行造影术，并随访术后1～2a内妊娠情况。结果输卵管妊娠206例，其中输卵管妊娠破裂型21例，流产型185例；行腹腔镜下患侧输卯管切除术45例，行腹腔镜取胚术161例。术后监测血HCG水平，204例降至正常，2例异常。发生持续性异位妊娠1例，发现宫内妊娠1例。输卵管妊娠保守性手术术后3个月输卵管造影结果显示输卵管通畅率达82．6％，随访1～2a宫内妊娠率达78．3％。结l论腹腔镜下手术治疗输卵管妊娠是目前较理想的手术方法，可提高输卵管通畅率及宫内妊娠率。术中注射甲氨蝶呤，术后严密监测血HCG水平，可避免持续性异位妊娠的发生。

Objective To explore the clinical application of laparoscopic treatment on tubal pregnancy. Methods A total of 206 patients with tubal pregnancy had been performed by laparoscopic operation according to the different condition. Blood human chorionic gonadotropin（HCG） level of the patients was detected after operation. Methotrexate was injected locally during the conservatism operation and the patients had angiography after 3 months later and pregnancy information had been followed up for 1 - 2 years. Results In the 206 cases of tubal pregnancy, there were 21 cases of rupture type tubal pregnancy and 185 cases of tubal abortion type. Forty-five cases had salpingectomy and 161 cases took the embryo under the laparo- scopes. The monitoring of blood HCG after the laparoscopic operation showed that blood HCG level of 204 cases reached the normal value and 2 cases were abnormal. One case had continued pregnancy and 1 case had intrauterine pregnancy. Salpingog- raphy results showed that tubal pateney rate reached 82.6%. The follow-up of 1 - 2 years showed that the intrauterine pregnan- cy rate was 78.3%. Conclusion Laparoscopic operation is the best method for the treatment on tubal pregnancy because it ean increase the tubal patency rate and intrauterine pregnancy rate. Occurrence of continued pregnancy can be avoided by in- jecting of methotrexate and closely monitoring of blood HCG.