输卵管妊娠保守性手术96例分析

Study of 96 tubal pregnancies after conservative surgery.

目的 探讨输卵管妊娠保守性手术及不同手术方式的近期效果及妊娠结局。方法 对 96例未破裂型输卵管妊娠中的 77例行输卵管线型切开术 ,19例行输卵管伞端胚囊挤出术。绒毛种植部位注射甲氨蝶呤 2 0～ 3 0mg。结果 2 4%的患者发生持续性异位妊娠 ,均为行伞端挤出术患者。宫内妊娠率为 4 1 5 %,重复异位妊娠率为 2 5 6%。对侧输卵管正常者 ,宫内妊娠率及重复异位妊娠率分别为 70 5 %和 2 2 8%;当对侧输卵管异常或已被切除者 ,宫内妊娠率及重复异位妊娠率为 7 9%和 2 8 8%。结论 绒毛种植部位注射甲氨蝶呤可降低持续性异位妊娠率 ,而伞端绒毛挤出术后发生持续性异位妊娠的可能性较大 ,应尽量避免。

Objective To study the early efficacy and subsequent fertility of open conservative surgery and different surgical management of tubal pregnancy.Methods In 96 cases of unruptured tubal pregnancies,77 cases were performed by linear salpingostomy,19 cases by fimbrial expression,and 20～30mg Methotrexate(MTX) was injected into gestation site.Results The rate of persistent ectopic pregnancy (EP) was 2.4%,all of them were performed fimbrial expression.The rates of subsequent intrauterine pregnancy (IUP) and recurrent EP were 41.5% and 25.6%,respectively.When the contralateral tube was normal,the rates of subsequent IUP and recurrent EP were 70.5% and 22.8%,respectively.When the contralateral tube was damaged or absent,the rates of subsequent IUP and recurrent EP were 7.9% and 28.8%,respectively.Conclusion Local injection of MTX during salpingostomy can decrease the risk of persistent EP.We'd better not perform fimbrial expression,which can cause higher incidence of persistent EP.