输卵管壶腹部妊娠腹腔镜下两种输卵管缝合方法对再次妊娠结局的影响

Comparison between two laparoscopic tubal suturing techniques on subsequent fertility outcomes in women with ampullary pregnancy

目的探讨输卵管壶腹部妊娠在腹腔镜下保留输卵管的2种输卵管缝合方法对再次妊娠的影响。方法选择输卵管壶腹部妊娠患者115例,采用腹腔镜对患侧输卵管壶腹部的妊娠部位沿着输卵管纵轴切开取胚,取胚后分为垂直纵轴间断缝合(常规组,53例)或平行纵轴间断缝合(改进组,62例),追踪2组患者在术后18个月内的妊娠情况。结果常规组53例中,宫内妊娠27例(51%)、再次异位妊娠12例(23%)、未孕16例(26%);改进组62例中,宫内妊娠44例(71%)、再次异位妊娠5例(8%)、未孕13例(21%)。与常规组相比,改进组的宫内妊娠率较高、再次异位妊娠率较低(P均<0.05)。结论腹腔镜下保守性手术中改变输卵管切开部位的缝合方式能够提高再次宫内妊娠率,输卵管平行纵轴间断缝合的手术方式可考虑在临床中推广。

Objective To investigate the effect between two laparoscopic tubal suturing techniques upon subsequent fertility outcomes in women diagnosed with ampullary pregnancy.Methods A total of 115 patients with ampullary pregnancy were recruited and their affected fallopian tubes were incised along with the longitudinal axis.Fifty-three patients receiving intermittent suturing vertical to the longitudinal axis were assigned into the conventional group, and 62 undergoing intermittent suturing parallel to the longitudinal axis were allocated into the modified group.The pregnancy outcomes between two groups were monitored within postoperative 18 months.Results In the conventional group（n=53）, 27 women achieved intrauterine pregnancy （51%）, 12 cases （23%） suffered from re-ectopic pregnancy and 16 cases were non-pregnant （26%）.In the modified group, 44 women achieved intrauterine pregnancy （71%）, 5 cases （8%） suffered from re-ectopic pregnancy and 13 cases were non-pregnant （21%）.Compared with the conventional group, the intrauterine pregnancy rate was significantly higher, whereas the re-ectopic pregnancy rate was considerably lower in the modified group （both P＆lt;0.05）.Conclusion Application of intermittent suturing parallel to the longitudinal axis of fallopian tube during laparoscopic conservative surgery can improve the intrauterine pregnancy rate, which deserves widespread application in clinical practice.