不同手术方式对输卵管妊娠术后再次妊娠的影响

Effects of two kinds of operation methods on subsequent pregnancy outcomes of patients with tubal pregnancy

目的探讨腹腔镜下超声刀、单极电切和开腹3种手术方式治疗输卵管妊娠对术后再次妊娠的影响。方法回顾性分析输卵管壶腹部妊娠177例,手术方式均为输卵管切开取胚术,其中采用腹腔镜下超声刀手术者71例(A组)、单极电切者54例(B组)、开腹手术者52例(C组),随访18个月,观察不同手术方式对术后再次妊娠结局的影响。结果 A组再次妊娠42例(59.2%),其中宫内妊娠30例(42.3%),重复性异位妊娠12例(16.9%),继发不孕29例(40.8%),输卵管通畅60例(84.5%);B组再次妊娠22例(40.8%),其中宫内妊娠13例(24.1%),重复性异位妊娠9例(16.7%),继发不孕32例(59.4%),术后输卵管通畅37例(68.5%);C组再次妊娠19例(36.6%),其中宫内妊娠12例(23.1%),重复性异位妊娠7例(13.5%),继发不孕33例(63.5%),输卵管通畅35例(67.3%)。A组与B组、A组与C组再次妊娠率、宫内妊娠率和输卵管通畅率差异均有显著性,但重复性异位妊娠率差异无显著性。3组的继发不孕率均较高,可能存在更多的影响妊娠的相关因素。3组重复性异位妊娠中输卵管粘连评分明显高于前次手术时的评分。结论输卵管妊娠采用腹腔镜下超声刀进行输卵管切开取胚术优于单极电切及开腹手术。输卵管粘连可能为术后重复异位妊娠及不孕的重要原因。

[ Objective ] To explore the effects of laparoscopic uhrasonic scalpel, monopolar electrocantery and laparotomy on subsequent pregnancy outcomes of patients with tubal pregnancy after surgery. [Methods] 177 patients with tubal ampullary pregnancy were analyzed retrospectively, the tubal incision and embryo surgical methods were all taken. 7I patients accepted laparoscopic ultrasonic scalpel operation （group A）, 54 patients accepted monopolar eleetrocautery（group B）, and 52 patients accepted laparotomy （group C）, all the patients were followed up for 18 months, the effects of three kinds of operation methods on subsequent pregnancy outcomes of patients after surgery were observed. [Results] 42 patients（59.2%） in group A got pregnancy, including 30 patients（42.3%） with intrauterine pregnancy and 12 patients （16.9%） with recurrent ectopic pregnancy, 29 patients （40.8%） were found with secondary infertility, 60 patients（84.5%） whose tubal were patency. 22 patients （40.8%） in group B got pregnan- cy, including 13 patients （24.1%） with intrauterine pregnancy and 9 patients （16.7%） with recurrent ectopic pregnancy, 32 patients （50.4%） were found with secondary infertility, 37 patients （68.5%） whose tubal were patency. 19 patients （36.6%） in group C got pregnancy, including 12 patients （23.1%） with intrauterine pregnancy and 7 patients （13.5%） with recurrent ectopic pregnancy, 33 patients （63.5%） were found with secondary infertility, 35 patients （67.3%） whose tubal were patency. There was significant difference of subsequent pregnancy rate, intrauterine pregnancy rate and tubal patency rate between group A and group B, between group A and group C. But there was no significant difference of recurrent ectopic pregnancy rate among the three groups. The secondary infertility rates of three groups were higher, and there may be more related factors affected pregnancy. The score of fallopian tube adhesion in the three recurrent ectopic pregnancy groups was significantly higher than that in the first operation. [Conclusion] Tubal pregnancy using laparoscopic ultrasonic scalpel to conduct the tubal incision and embryo surgery is superior over monopolar electrocautery and laparotomy. The fallopian tubal adhesion may be the important reason of recurrent ectopic pregnancy and secondary infertility after operation.