腹腔镜下两种保守手术治疗输卵管妊娠的临床疗效与妊娠结局评价

Clinical efficacy and pregnancy outcome evaluation of two kinds of conservative operation under laparoscope for tubal pregnancy

目的分析腹腔镜下两种保守手术治疗输卵管妊娠的临床疗效及对再次妊娠结局的影响。方法选取2014年4月至2015年8月惠州市第一妇幼保健院收治的输卵管妊娠患者86例,采用随机数字表法将其分为研究组与对照组,各43例。研究组采取腹腔镜下输卵管切开取胚缝合术,对照组采用腹腔镜下输卵管开窗取胚术。对比两组手术时间、术中出血量及排气时间,第2次月经后输卵管通畅、输卵管瘘及盆腔粘连情况。随访2年,统计宫内妊娠、再次异位妊娠、继发性不孕的发生情况,并比较妊娠结局。结果研究组手术时间长于对照组,差异有统计学意义(P<0.05),两组术中出血量及排气时间差异无统计学意义(P>0.05);术后研究组输卵管通畅率高于对照组,输卵管瘘发生率及盆腔粘连率低于对照组,差异均有统计学意义(P<0.05);研究组术后2年内宫内妊娠率高于对照组,再次异位妊娠率及继发性不孕率低于对照组,差异均有统计学意义(P<0.05);两组再次妊娠的母体及胎儿或新生儿的总不良结局发生率差异均无统计学意义(P>0.05)。结论腹腔镜下输卵管切开取胚缝合术创伤小、恢复快,可提高输卵管通畅率和宫内妊娠率,并减少再次异位妊娠及继发性不孕的发生,对再次妊娠结局无明显影响。

Objective To analyze the clinical effect of two kinds of conservative operation under laparoscope on tubal pregnancy and the influence on the second pregnancy outcomes. Methods 86 patients of tubal pregnancy were selected from April 2014 to August 2015 in Huizhou First Maternal and Child Health Hospital, who were divided into study group and control group by using random digital table method, with 43 cases in each. The study group was treated by laparoscopic oviduct incision and embryo extraction with tubal incision suture, the control group by laparoscopic oviduct opening and embryo extraction. The operation time, amount of bleeding and time of exhaust were compared, as well as the condition of tubal patency, fallopian fistula and pelvic adhesions after second menstruation. After following up for 2 years, the incidences of intrauterine pregnancy, ectopic re - pregnancy and secondary infertility were counted, and the outcomes of intrauterine pregnancy were compared. Results The operation time of the study group was longer than the control group, with a statistically significant difference （ P 〈 0. 05 ）, without statistically significant difference in the amount of bleeding and the exhaust time （ P 〉 0.05 ）. After operation, the patency rate of the fallopian tube of the study group was higher than the control group, with a statistically significant difference （ P 〈 0. 05 ） , the incidence rates of fallopian tube fistula and pelvic adhesion lower, with statistically significant differences （ P 〈 0.05 ）. The rate of the intrauterine pregnancy of the study group within 2 years after operation was higher than that of the control group, with a statistically significant difference （ P 〈 O. 05 ）, and the rates of the ectopic re -pregnancy and secondary infertility of the study group were lower, with statistically significant differences （P 〈 0. 05 ）, without statistically significant difference in the total bad outcome rates of pregnant women and fetus or newborns （P 〉 0. 05 ）. Conclusion Laparoscopic oviduct incision and embryo extraction with tubal incision suture has less injury and quick recovery, and it can improve the rates of fallopian tube pateney and intrauterine pregnancy, reduce the occurrences of ectopic re - pregnancy and secondary infertility, without obvious effect on the outcomes of the second pregnancy.