腹腔镜输卵管伞端复通术中不同止血方法的生殖预后分析

Analysis of reproductive prognosis of different hemostasis during laparoscopic recanalization of uterine tube fimbriae

目的:探讨腹腔镜输卵管伞端复通术中复原输卵管生殖功能有效的止血方法。方法:选择2011年12月至2013年12月收治的92例输卵管伞端粘连患者为研究对象,机械抽样随机将其中58例分为实验组,采用改良手术步骤;34例为对照组,采用传统手术步骤。结果:实验组手术时间平均(44.5±10.2)min,显著低于对照组[(68.5±12.8)min](P<0.05);术中出血量平均(24.1±6.2)ml,显著低于对照组[(46.3±5.8)ml](P<0.05);术后肛门排气时间平均(1.5±0.4)d,显著低于对照组[(2.6±0.6)d](P<0.05)。实验组术后妊娠率为53.4%,显著高于对照组(29.4%)(P<0.05);实验组术后异位妊娠率为3.2%,显著低于对照组(40.0%)(P<0.05)。实验组未妊娠者输卵管再堵塞率为14.8%,显著低于对照组的45.8%(P<0.05)。实验组术前及用药10 min后舒张压及收缩压差异均无统计学意义(P>0.05)。结论:加用垂体后叶素的止血方式,可显著减少组织损伤,利于输卵管生殖功能复原,不但提高了术后宫内妊娠率,也有效降低了异位妊娠率。

Objective：To explore the more effective method of hemostasis for recovery of oviduct reproductive function during laparoscopic recanalization of uterine tube fimbriae. Methods：From Dec. 2011 to Dec. 2013,92 cases of uterine tube fimbriae adhesion were selected and randomly divided into two groups. 58 cases in experiment group were treated by improved surgery,34 cases in control group underwent traditional surgery. Results： Between the experiment group and the control group,operation time was（ 44. 5 ±10. 2） min vs.（68. 5 ± 12. 8） min（ P 0. 05）,the intraoperative blood loss was（24. 1 ± 6. 2） ml vs.（46. 3 ± 5. 8） ml（ P 0. 05）,the postoperative anal exhaust time was（1. 5 ± 0. 4） d vs.（2. 6 ± 0. 6） d（ P 0. 05）,the postoperative pregnancy rate was 53. 4%vs. 29. 4%,the ectopic pregnancy rate was 3. 2% vs. 40. 0%（ P 0. 05）,the oviduct re-blocking ratio of non-pregnant patients was14. 8% vs. 45. 8%（ P 0. 05）. In experiment group,the diastolic and systolic blood pressure before operation and in ten min after surgery were not significantly different（ P 0. 05）. Conclusions：Improved hemostasis with pituitrin significantly reduces tissue injury and ectopic pregnancy rate,is conducive to recovery of oviduct reproductive function,and increases the postoperative intrauterine pregnancy rate.