两种输卵管妊娠手术方式的临床对比分析

Clinical Comparison and Analysis of the Two Different Operation Methods of Tubal Ectopic Pregnancy

目的比较输卵管妊娠保守性手术和输卵管全切除术的临床应用价值与安全性。方法回顾性分析2014年01月至2016年06月常州市第七人民医院行手术治疗的67例输卵管妊娠患者的临床资料,其中26例行输卵管保守性手术,41例行患侧输卵管全切除术。通过观察两组患者年龄、妊娠次数、输卵管妊娠部位、盆腔粘连、腹腔内出血量、术后血HCG下降情况、持续性异位妊娠发生率、术后输卵管通畅及月经恢复情况,比较并分析两种手术方式的优缺点。结果保守性手术组年龄、妊娠次数及腹腔内出血量低于输卵管全切除术组(P<0.05);两组均以输卵管壶腹部妊娠为主;所有患者经手术治疗后三天血HCG下降明显,输卵管全切除术组下降较保守性手术组明显(P<0.05);两组均无一例发生持续性异位妊娠,其中保守性手术组术中有9例局部注射甲氨蝶呤(MTX)30mg;保守性手术组术后输卵管造影有14例患侧输卵管通畅;术后两组患者月经恢复情况无明显差异(P>0.05)。结论对于输卵管妊娠的手术治疗,保守性手术和输卵管全切除术两种术式均是安全有效的。对年轻的或有意愿保留输卵管器官完整性的患者,如能早期明确诊断,可行保留输卵管的保守性手术,术中局部MTX的注射可能有助于防止持续性异位妊娠的发生。

Objective To compare the clinical efficacy and security between conservative surgical treatment/salpingostom and salpingectomy for tubal ectopic pregnancy. Methods From January 2014 to June 2016, totally 67 patients with tubal ectopic pregnancy treated in the 7th People＇s Hospital of Changzhou were studied retrospectively. 26 patients were treated with salpingostom, while 41 patients were treated with salpingectomy. The following clinical parameters were compared, including age, number of conception, pregnancy sac position, pelvic adhesion, abdominal cavity blood loss, the decrease of serum HCG, the incidence of persistent ectopic pregnancy, tubal patency and menstruation recovery. Results In salpingostom group, the age, number of conception and volume of abdominal cavity blood loss are lower than in the salpingectomy group （P〈0.05）. Most tubal pregnancy in two groups are ampulla pregnancies, serum HCG drops obviously at the third day after surgery in two groups, more obvious in salpingectomy group （P〈0.05）. No case of persistent ectopic pregnancy in two groups, while nine patients in the salpingostom group were treated with tubal injection of methotrexate （MTX） 30 rag. Patients in the salpingostom group were treated with hystero-salpingography postoperative with 14 cases of the operation side were unobstructed. Menstruation recovery of patients in two groups has no obvious difference （P〉0.05）. Conclusion Both salpingostom and salpingectomy for tubal ectopic pregnancy could be effective and safe. For the younger or the patients intending to retain the integrity of the fallopian tube could be treated with salpingostom, and the tubal injection of MTX in the operation may help to prevent the occurrence of persistent ectopic pregnancy.