不同治疗方案下输卵管妊娠患者的妊娠结局对比

Comparison of pregnancy outcome of different methods for treatment of tubal pregnancy

目的比较不同治疗方案下输卵管患者的妊娠结局。方法回顾性分析2010年2月至2014年1月间来我院治疗的918例输卵管妊娠且有生育要求的患者病例,其中手术治疗有560例(A组),选择药物治疗231例(B组),期待疗法127例(C组)。观察并比较三组患者治疗后患侧输卵管复通情况,并对病例电话随访,了解治疗后妊娠结局情况,子宫内妊娠、异位妊娠、继发性不孕。结果 A组输卵管畅通率优于B、C组;C组输卵管畅通率优于B组,差异有统计学意义(P<0.05);三组患者子宫内妊娠率A组高于B、C组,B组高于C组,差异有统计学意义(P<0.05);再次异位妊娠三组发生率差别有统计学意义(P<0.05),B组最高,其中A组、C组间发生率差别无统计学意义(P>0.05);三组患者继发性不孕发生率A组低于B组低于C组,差别均有统计学意义(P<0.05);不同手术方式治疗的输卵管妊娠患者子宫内妊娠、再次异位妊娠、继发不孕发生率相比,差异均有统计学意义(P<0.05),腹腔镜组高于开腹手术组。结论异位妊娠的患者治疗手术治疗效果最好,再次妊娠率较高,其中腹腔镜手术效果优于开腹手术,且创伤较小,风险较低,痛苦少,可作为首选的治疗方式。

Objective To explore the reproductive of different management strategies of tubal pregnancy.Methods 918 patients diagnosed as tubal pregnancy were selected between February 2010 and January 2014,in accordance with the wishes of patients into three groups for treatment,surgical treatment,560 cases（ group A）,select drugs in the treatment of 231 cases（ group B）,expectant treatment,127 cases（ group C）,observe and compare the three groups of patients experienced side oviduct after treatment,and the cases of telephone followup,understand the pregnancy outcome after treatment,intrauterine pregnancy and ectopic pregnancy,secondary infertility. Results Fallopian tube flow rate of group A was better than that of group B and C; Fallopian tube flow rate is better than that of group B,group C difference was statistically significant（ P〈0. 05）; Three groups of patients with intrauterine pregnancy rate in group A than group B,C,group B was higher than C group,the difference was statistically significant（ P〈0. 05）; Incidence of ectopic pregnancy again three groups was statistically significant difference（ P〈0. 05）,group B was highest,of which the rate difference between group A and group C had no statistical significance（ P〈0. 05）; Three groups of patients with secondary infertility rates in group A than group B than in group C,the difference had statistical significance（ P〈0. 05）; Different surgical treatment of tubal pregnancy patients with intrauterine pregnancy and ectopic pregnancy again,compared the incidence of secondary infertility,differences were statistically significant（ P〈0. 05）,laparoscopic group was higher than open surgery group. Conclusions Ectopic pregnancy patients with treatment of surgical treatment for the best effect,higher pregnancy rates again,which effect is superior to laparotomy,laparoscopic surgery and trauma is small,the risk is low,less painful,can be used as the preferred treatment.