输卵管妊娠腹腔镜保守性手术不同输卵管血供预处理的比较

Comparison of the pretreatments of tubal blood supply in laparoscopic conservative surgery for tubal pregnancy

目的:对比腹腔镜下输卵管妊娠保守性手术不同输卵管血供预处理的临床疗效。方法:收集2014年6月~2016年6月共61例输卵管妊娠患者临床资料,患者随机分为两组,术中进行不同输卵管血供预处理方法。缝扎组(n=31例):用3-0可吸收线在输卵管病灶系膜缘结扎进行输卵管血供预处理,再于输卵管妊娠部位线形切开行取胚术;电凝组(n=30例):于输卵管病灶膨大处近输卵管系膜侧缘电凝进行输卵管血供预处理,再沿输卵管长轴方向线形切开行取胚术。比较两组术中出血量、手术时间及术后β-HCG变化、愈后输卵管通畅情况。结果:缝扎组患者手术均获得成功,电凝组2例术中出血迅猛,因止血困难行输卵管切除术,1例持续性异位妊娠氨甲喋呤+米非司酮保守治疗治愈;缝扎组平均手术时间(37. 5±12. 3) min,电凝组平均手术时间(46. 1±10. 5) min,两组比较,差异有统计学意义(t=2. 940,P=0. 005);缝扎组术中平均出血量(23±2) ml,电凝组平均出血量(50±3) ml,两组比较,差异有统计学意义(t=41. 49,P=0. 000);缝扎组术后1 dβ-HCG下降率、持续性异位妊娠发生率与电凝组比较,差异无统计学意义(t=1. 085,P=0. 282); 59例患者术后第1次月经后行输卵管通液检查,缝扎组通畅者27例,占87. 1%(27/31),电凝组通畅者20例,占71. 4%(20/28),两组比较,差异有统计学意义(χ~2=9. 251,P=0. 015)。结论:腹腔镜缝扎输卵管系膜血供预处理操作简单,控制出血效果好,术中创面出血少、减少术后PEP风险,增加远期输卵管再通率,对育龄妇女保留生育功能十分有益,值得临床推广应用。

Objective To compare the curative effects of different pretreatments of tubal blood supply in laparoseopie conservative surgery for tubal pregnancy. Method Clinical data were collected from 61 eases of tubal pregnancy from June 2014 to June 2016. The patients were randomly divided into 2 groups,i, e. suture group （n = 31 ） and eleetroeoagulation group （n = 30） ,which were pretreated with different motheds for tubal blood supply in the operation. Suture group ： ligating the mesovarial margin of the tubal lesions with 3 -0 absorbable thread, and taking embryo by linear incision into the tubal part of pregnancy. Eleetroeoagulation group ： eleetroeoagulating the proximal mesovarial margin of the enlarged tubal lesions, and taking embryo by linear incision into the fallopian tube along its long axis. The amount of blood loss, time consumption of the operation, postoperative alteration of the beta - HCG and the pateney of the fallopian tube after operation were compared between the 2 groups. Results In the suture group all surgery was completed with success ,while in the eleetroeoagulation group 2 eases met with rapid intraoperative bleeding：one had a salpingeetomy,the other （persistent eetopie pregnancy） was conservatively treated with methotrexate ＋ mifepristone. The average time consumption of the operation was （ 37. 5 ±12.3 ） min in the suture group and （46. 1± 10. 5 ） min in the eleetroeoagulation group, with a significant diffenee （t = 2. 940, P = 0. 005 ）. The amount of blood loss was （23± 2）ml in the suture group and （50 ± 3） ml in the eleetroeoagulation group,with a significant diffenee （t = 41.49, P = 0. 000）. The decline rate of beta - HCG one day postoperative and the incidence of persistent eetopie pregnancy were not significantly different between the two groups （t = 1. 085, P = 0. 282）. After the first postoperative menstruation, the rates of tubal pateney were 87. 1% （27/31） in the suture group and 71.4% （20/28） in the other,with a significant diffenee （X2 = 9. 251,P = 0. 015 ）. Conclusion The pretreatment of laparoscopic ligation of the mesosalpinx has the advantages of simple operation, good effect to control intraoperative bleeding, reducing the postoperative risk of PEP and increasing the long - term tubal reeanalization rate. It is benifieal for women of reproductive age to preserve fertility, and is worthy of clinical application.