输卵管壶腹部妊娠取胚术后是否关闭管腔对生育功能影响的研究

Study on the effect of closing or not closing the lumen on fertility after tubal ampullary pregnancy

目的研究腹腔镜下输卵管壶腹部妊娠开窗取胚术中是否缝合关闭管腔对术后输卵管通畅性及妊娠率的影响。方法对2016年6月至2017年1月在北京大学深圳医院因输卵管壶腹部妊娠行腹腔镜下开窗取胚术的39例患者,根据术中是否关闭输卵管管腔,分为A组(缝合输卵管浆肌层关闭管腔组,18例)及B组(未缝合组,21例)。术后3个月行输卵管超声微泡造影了解输卵管通畅性,并随访术后24个月内的妊娠率。结果①输卵管通畅性:两组均有2例双侧输卵管阻塞;A组患侧的输卵管通畅率为72.22%,高于B组(38.09%),但差异无统计学意义(P>0.05);A、B组健侧输卵管通畅率分别为83.33%和71.43%,差异无统计学意义(P>0.05)。②术后妊娠率:A组宫内妊娠率(55.56%)高于B组(38.09%),异位妊娠A组1例,B组2例,差异均无统计学意义(P>0.05)。结论腹腔镜下输卵管开窗取胚术术中缝合浆肌层恢复输卵管解剖结构有利于保护输卵管功能,提高术后妊娠率。

Objective To assess the impact of closing or not closing the lumen on fertility after tubal ampullary pregnancy. Methods From June 2016 to January 2017, 39 patients who underwent laparoscopic fenestration in the fallopian tube ampullary pregnancy at Peking University Shenzhen Hospital were divided according to whether the fallopian tube lumen was closed during operation into group A(the fallopian tube muscle layer closed the lumen group) and the B group(unsewed group). Three months after operation, the fallopian tube ultrasound microbubble was used to understand the patency of the fallopian tube, and the pregnancy rate was followed up 24 months after operation. Results ① Tubal patency: There were 2 cases of bilateral fallopian tube obstruction in group A(surgical group, n=18 cases) and group B(unsewed group, n=21 cases);The patency rate of the fallopian tube was 72.22 %, which was higher than that of the B group, which was 38.09 %, but the difference was not statistically significant(P>0.05). The contralateral fallopian tube patency rate was 83.33 % and 71.43 %, respectively. The difference was not statistically significant(P>0.05).② Postoperative pregnancy rate: The intrauterine pregnancy rate of group A(55.56 %) was higher than that of group B(38.09 %), the ectopic pregnancy cases of group A was 1 case, group B 2 cases, but there were no statistical significance(P>0.05). Conclusion Laparoscopic fallopian tube fenestration and suture of the muscle layer to restore the fallopian tube anatomy is beneficial to protect the fallopian tube function and improve the postoperative pregnancy rate.