腹腔镜与开腹保留输卵管手术治疗输卵管妊娠的临床疗效比较

Comparison of the clinical effect of preserving fallopian tube by laparoscopy and laparotomy for the treatment of tubal pregnancy

目的:比较腹腔镜与开腹保留输卵管手术治疗输卵管妊娠的临床效果。方法:对102例保守手术治疗输卵管妊娠的临床资料进行回顾性分析,其中腹腔镜手术治疗52例(腔镜组),开腹手术治疗50例(开腹组),两组病例均采取输卵管开窗术,并在输卵管系膜局部注射50mg甲氨喋呤,观察两组手术效果。结果:腔镜组术中出血量[(82.38±20.88)ml]与开腹组出血量[(82.38±20.88)ml]比较,差异有统计学意义(P<0.05);腔镜组腹部手术切口长度[(2.44±0.36)cm]明显小于开腹组[(7.62±0.98)cm],两者差异有统计学意义(P<0.05);腔镜组术后曲马多镇痛用量[(253.85±122.41)mg]明显要少于开腹组[(528.00±152.92)mg],其差异有统计学意义(P<0.05);腔镜组患者术后首次肛门排气时间[(23.04±4.27)h]与开腹组[(29.64±5.28)h]比较,差异具有统计学意义(P<0.05);腹腔镜组首次下床活动时间[(10.44±1.86)h]与开腹组[(27.97±3.11)h]比较,两者差异有统计学意义(P<0.05);腔镜组住院时间[(4.83±1.46)d]明显短于开腹组[(8.36±2.35)d],差异具有统计学意义(P<0.05);腔镜组住院费用[(4.26±0.77)万元]明显高于开腹组[(2.79±0.410)万元],两者差异有统计学意义(P<0.05);腔镜组患者恢复日常工作所需时间[(13.75±2.19)d]明显短于开腹组[(18.64±5.47)d],差异有统计学意义(P<0.05);腔镜组患者术后3个月输卵管通畅率78.85%明显高于开腹组66.00%,两者差异有统计学意义(P<0.05)。两组的手术时间、手术并发症发生率、血β-HCG降至正常时间、月经恢复时间及1.5年内同侧重复异位妊娠发生率比较差异无统计学意义(P>0.05)。结论:腹腔镜和开腹保留输卵管手术均能有效治疗输卵管妊娠,但腹腔镜手术具有显著的微创效果,且能提高输卵管通畅率,非常适合有生育要求的女性。

Objective To explore and compare the clinical efficacies of preserving fallopian tube peritoneoscope surgery and traditional operation in treatment of tubal ectopic pregnancy. Method Retrospective analysis of 102 cases of conservative surgery for the treatment of tubal pregnancy clinical data,including 52 patients receiving laparoscopy（ laparoscopy group）and 50 patients receiving laparotomy（ laparot-omy group）;two group were both treated by tubal fenestration with mesosalpinx local injection 50 mg methotrexate,then the result of opera-tion two groups were observed. Results There was significant difference in the amount of blood loss during operation between laparoscopy group[（82. 38 ± 20. 88）ml]and laparotomy group[（82. 38 ± 20. 88）ml]（P〈0. 05）;the incision length of abdominal region in laparos-copy group[（2. 44 ± 0. 36）cm]was shorter than laparotomy group[（7. 62 ± 0. 98）cm]with significant difference（P〈0. 05）;consump-tion of tramadol after operation in laparoscopy group[（253. 85 ± 122. 41）mg]was less than laparotomy group[（528. 00 ± 152. 92）mg] with significant difference（P〈0. 05）;the first of anal exhausting time after operation in laparoscopy group[（23. 04 ± 4. 27）hours]was shorter than laparotomy group[（29. 64 ± 5. 28）hours]with significant difference（P〈0. 05）;the first of exercise time leaving bed after operation in laparoscopy group[（10. 44 ± 1. 86）hours]was shorter than laparotomy group[（27. 97 ± 3. 11）hours]with significant differ-ence（P〈0. 05）;the hospitalization time in laparoscopy group[（4. 83 ± 1. 46）days]was shorter than laparotomy group[（8. 36 ± 2. 35） days]with significant difference（P〈0. 05）;the hospitalization fee in laparoscopy group[（4. 26 ± 0. 77）million yuan]was lower than laparotomy group[（ 2. 79 ± 0. 410 ） million yuan ] with significant difference（P〈0. 05）;the time of recovered daily work in laparoscopy group[（13. 75 ± 2. 19）days]was shorter than laparotomy group [（18. 64 ±5. 47）days]with significant difference（P〈0. 05）;the patency rate of fallopian tubes in laparoscopy group（78. 85%）was higher than laparotomy group（66. 00%）with significant difference（P〈0. 05）. There was no statistical difference between two groups in the operation time,postoperative complications,the time of the blood β-human chorionic gonadotropin（β-HCG）decreased to normal range,the time of menstruation recovery and the rate of ipsilateral repeat ectopic pregnancy within 1. 5 yearˊs after surgery（ P〉0. 05 ） . Conclusion preserving fallopian tube laparoscopy and traditional operation in treatment of tubal ectopic pregnancy are effective;Moreover, laparoscopy is very suitable to the patient who desires for fertility,as a result of its micro-invasion and can enhance the patency rate of fal-lopian tubes.