腹腔镜手术治疗与药物保守性治疗异位妊娠的临床对比分析

Clinical comparative analysis of laparoscopic surgery and medicine conservative therapy in treatment of ectopic pregnancy

目的探讨腹腔镜手术治疗与药物保守治疗对异位妊娠临床疗效以及生育功能的影响。方法收集2009年1月～2011年10月在我院就诊的异位妊娠患者237例,根据患者不同情况分为腹腔镜手术组（观察组）和药物保守治疗组（对照组）,分别给予腹腔镜手术和药物保守治疗,对比两组患者的临床疗效以及生育功能。结果腹腔镜手术组住院时间（5.8±2.4）d和HCG恢复正常时间（13.6±6.3）d,均显著低于药物保守治疗组的（13.2±4.1）d和（15.2±5.7）d,差异有统计学意义（P〈0.05）,腹腔镜手术组输卵管通畅率（78.91%）显著高于药物保守治疗组的（67.89%）,差异有统计学意义（P〈0.05）。腹腔镜手术组宫内受孕的成功率53.91%,药物保守治疗组56.88%,差异无统计学意义（P〉0.05）。腹腔镜手术组再次异位妊娠率（11.72%）显著低于药物保守治疗组（21.10%）,差异有统计学意义（P〈0.05）。结论腹腔镜手术治疗与药物治疗都是异位妊娠患者保留生育功能的治疗方法,两者的后期宫内妊娠率差异无统计学意义,对早期未破裂型输卵管妊娠,可以选择药物治疗,而对于发生输卵管破裂或流产者,应争取尽早采取腹腔镜保守性手术。

Objective To discuss clinical therapeutic effect of laparoscopic surgery and medicine conservative therapy in treatment of ectopic pregnancy and the impact on reproductive function. Methods A total of 237 patients with ectopic pregnancy were collected who were admitted to the hospital from January 2009 to October 2011. According to different patients＂ condition, the patients were divided into lap- aroscopic surgery group （observation group） and medicine conservative therapy group （control group） . The patients in the two groups were treated with laparoscopic surgery and medicine conservative therapy respectively, and clinical efficacies and their reproductive functions in the two groups were compared. Results In observation group, hospitalization time and the time for human chorionic gonadotropin （hCG） return to normal level were （5.8±2.4） days and （ 13.6±6. 3） days, respectively, which were statistically significantly lower than those in control group （ （ 13.2±4.1 ） days and （ 15.2±5.7 ） days ] （ P〈0. 05 ） . The tubal patent rate in observation group （78.91%） was statistically significantly higher than that in control group （67.89%） （P〈0. 05 ） . The successful rates of intrauterine insemination in observation group and control group were 53.91% and 56. 88% , respectively, and there was no significant difference （P〉0. 05 ） . The recurrence of ectopie pregnancy in observation group （11.72% ） was statistically significantly lower than that in control group （21.10%） （P〈0. 05 ） . Conclu- sion Laparoscopic surgery and medicine conservative therapy are both treatments that can preserve fertility function, and there are no signif- icant difference in late intrauterine pregnancy rate. For those patients with early-stage unruptured tubal pregnancy, medicine treatment can be used, while for those with ruptured tubal pregnancy or abortion, laparoseopy conservative surgery should be performed as soon as possible.