经阴道宫腔镜手术与腹腔镜手术对输卵管妊娠的疗效比较

Comparison of the Clinical Efficacy of Vaginal Hysteroscopy and Laparoscopic Surgery in the treatment of Patients with Tubal Pregnancy

目的:比较经阴道宫腔镜手术与腹腔镜手术对输卵管妊娠的临床疗效和安全性。方法:选取2013年3月至2015年3月在我院接受治疗的输卵管妊娠患者95例,按照手术方式的不同分为对照组48例和观察组47例。对照组患者给予腹腔镜手术治疗,观察组患者给予经阴道宫腔镜手术治疗。比较两组手术时间、术中出血量、排气时间、住院时间、症状消失时间以及手术结果,炎性因子包括血清C反应蛋白(CRP)、白细胞介素2(IL-2)、白细胞介素6(IL-6)、白细胞介素8(IL-8)水平的变化。结果:两组的手术时间、术中出血量、住院时间以及症状消失时间比较差异无统计学意义(P>0.05);而观察组的排气时间显著短于对照组(P<0.05);术后,观察组的学期CRP、IL-2、IL-6、IL-8水平显著低于对照组,差异具有统计学意义(P<0.05)。两组的手术成功率、患侧输卵管通畅率比较差异无统计学意义(P>0.05);而观察组的再次宫内妊娠率显著高于对照组,不良反应发生率显著低于对照组,差异具有统计学意义(P<0.05)。结论:经阴道宫腔镜手术和腹腔镜手术治疗输卵管妊娠均效果良好,而经阴道宫腔镜手术在抑制炎症和提高再次宫内妊娠率的效果更优,且安全性更高。

Objective： To compare the clinical efficacy and safety of vaginal hysteroscopy and laparoscopic surgery in the treatment of patients with tubal pregnancy. Methods： Ninety-five patients with tubal pregnancy admitted in our hospital from March 2013 to March 2015 were randomly divided into the control group and the observation group. Forty-eight patients in the control group were treated with vaginal hysteroseopy surgery, while forty-seven patients in observation were treated with laparoscopic surgery treatment. The operative time, intraopemtive blood loss, exhaust time, hospital stay and symptoms vanished time, changes of inflammatory factors including CRP, IL-2, IL-6, and IL-8 and operative outcome were analyzed and compared. Results： No obvious difference was found in the operative time, intraopemtive blood loss, hospital stay and symptoms vanished time between the two groups （P 〉0.05）, while the exhaust time of observation group was significantly shorter than that of control group （P 〈0.05）. After treatment, the serum CRP, IL-2, IL-6, and 1I,-8 levels in the observation group were markedly lower than those in the control group （P ＂〈0.05）. And no significant difference was found in the operative success rate and tubal patency rate between the two groups （P 〉0.05）, while the intrauterine pregnancy rate of observation group was 68.1%, which was significantly higher than that of control （52.1%）, and the incidence rate of adverse reactions was 10.6%, which was much lower than that of control group（18.6%, P 〈 0.05）. Conclusion： Both vaginal hysteroscopy and laparoscopic surgery had good efficacy in the treatment of patients with tubal pregnancy, while vaginal hysteroscopy surgery could significantly inhibit the inflammatory response, improve the intrauterine pregnancy rate with higher safety.