腹腔镜输卵管妊娠保守性手术后持续性异位妊娠的处理方式研究

Study on treatment of persistent ectopic pregnancy after conservative operation of laparoscopic tubal pregnancy

目的探讨两种不同的处理方式在预防腹腔镜输卵管妊娠保守性手术后持续性异位妊娠中的临床效果。方法选取2015年6月21日~2017年8月25日我院收治的40例输卵管妊娠行腹腔镜保守手术患者作为研究对象,按照不同的治疗方式将其分为两组,每组各20例。观察组患者于输卵管妊娠病灶清除术中行输卵管系膜MTX注射,对照组患者于术后肌注MTX。比较两组患者的手术时间、术中出血量、术后血β-HCG水平降至正常时间以及手术后并发症持续性异位妊娠发生率。结果观察组患者的手术时间长于对照组,差异有统计学意义(P<0.05);观察组患者的术后血β-HCG水平降至正常时间短于对照组,差异有统计学意义(P<0.05);两组患者的术中出血量比较,差异无统计学意义(P>0.05);观察组患者的手术后并发症持续性异位妊娠发生率低于对照组,差异有统计学意义(P<0.05)。结论输卵管妊娠病灶清除术中行输卵管系膜MTX注射效果显著,可有效的清除残余滋养细胞,促使血β-HCG水平恢复正常值,临床上值得应用和推广。

Objective To investigate the clinical effect of two different kinds of treatment in the prevention of persistent ectopic pregnancy after conservative operation of laparoscopic fallopian tube pregnancy.Methods Forty patients with tubal pregnancy underwent laparoscopic conservative surgery from June 21,2015 to August 25,2017 were divided into two groups according to different treatment methods,20 cases in each group.The patients in the observation group were injected with MTX of the tubal mesangial MTX during the removal of the tubal pregnancy lesion,while the control group was treated with MTX postoperative muscle injection.The operation time,intraoperative blood loss and the time of post- operative blood β-HCG level reduced to normal and postoperative comphcations of persistent ectopic pregnancy were compared.Results The operation time of the observation group was higher than that of the control group,the difference was statistically significant （P〈0.05）.The time of postoperative blood β-HCG level reduced to normal in the observation group was shorter than that in the control group,the difference was statistically significant （P〈0.05）.The intraoperative blood loss was compared between the two groups,and the difference was not statistically significant （P〉0.05）.The post- operative complications of persistent ectopic pregnancy in the observation group was lower than that in the control group,the difference was statistically significant （P〈0.05）.Conclusion The effect of MTX injection on tubal mesentery in the treatment of tubal pregnancy is effective,which can effectively remove residual trophoblast cells and promote the re- turn of blood [3-HCG level to normal value.It is worthy to be applied and popularized clinically.