腹腔镜开窗取胚术联合甲氨蝶呤局部注射治疗异位妊娠的效果及对患者再孕的影响

Effect of laparoscopic fenestration embryo removal combined with local injection of methotrexate on ectopic pregnancy and its influence on re-pregnancy

目的:探讨腹腔镜开窗取胚术联合甲氨蝶呤局部注射治疗异位妊娠的效果及对患者再孕的影响。方法:抽取2017年2月至2018年12月枣庄市妇幼保健院收治的行腹腔镜开窗取胚术治疗的异位妊娠患者136例。根据治疗方式不同分为单纯腹腔镜开窗取胚术组(62例)和腹腔镜开窗取胚术联合甲氨蝶呤局部注射组(74例)。比较两组患者的术后恢复情况、输卵管畅通情况、再怀孕宫内妊娠情况。结果:单纯腹腔镜开窗取胚术组患者住院时间、月经恢复正常的时间、血清人绒毛膜促性腺激素(β-HCG)恢复正常时间、包块消失时间长于腹腔镜开窗取胚术联合甲氨蝶呤局部注射组(P<0.05)。腹腔镜开窗取胚术联合甲氨蝶呤局部注射组输卵管完全通畅率高于单纯腹腔镜开窗取胚术组,而部分通畅率和不通畅率低于单纯腹腔镜开窗取胚术组(P<0.05)。随访1.5年,两组均无失访病例。腹腔镜开窗取胚术联合甲氨蝶呤局部注射组再次怀孕宫内妊娠率高于单纯腹腔镜开窗取胚术组,而再次异位妊娠率和流产率低于单纯腹腔镜开窗取胚术组(P<0.05)。结论:腹腔镜开窗取胚术联合甲氨蝶呤局部注射治疗异位妊娠疗效较好,患者术后恢复较快,术后康复时间缩短,输卵管完全通畅率和再次怀孕宫内妊娠率提高,再次异位妊娠率和流产率降低。

Objective To explore the effect of laparoscopic fenestration embryo retrieval combined with local injection of methotrexate on ectopic pregnancy and its influence on the re-pregnancy.Methods A total of 136 cases of ectopic pregnancy treated by laparoscopic fenestration embryo retrieval in Maternal and Child Health Hospital of Zaozhuang City from February 2017 to December 2018 were selected.According to different treatment methods,they were divided into simple laparoscopic fenestration embryo extraction group(62 cases)and laparoscopic fenestration embryo extraction combined with local methotrexate injection group(74 cases).The postoperative recovery,fallopian tube patency,re-pregnancy and intrauterine pregnancy were compared between the two groups.Results The hospitalization time,menstruation recovery time,serum beta-human chorionic gonadotrophin(β-HCG)returned to normal time and mass disappearance time of patients in simple laparoscopic fenestration embryo extraction group were longer than those in laparoscopic fenestration embryo extraction combined with local methotrexate injection group(P<0.05).The tubal patency rate of laparoscopic fenestration embryo extraction combined with local methotrexate injection group was significantly higher than that of simple laparoscopic fenestration embryo extraction group,while the partial patency rate and obstructed rate were lower than those of simple laparoscopic fenestration embryo extraction group(P<0.05).Follow-up for one and a half years,no cases were lost to follow-up in both groups.The intrauterine pregnancy rate of laparoscopic fenestration embryo extraction combined with local methotrexate injection group was higher than that in simple laparoscopic fenestration embryo extraction group,while the rates of re-ectopic pregnancy and abortion were lower than those in simple laparoscopic fenestration embryo extraction group(P<0.05).Conclusions Laparoscopic fenestration embryo extraction combined with local methotrexate injection is effective in the treatment of ectopic pregnancy.The patients recover faster,the postoperative recovery time is shorter,the complete patency rate of fallopian tube and the rate of re pregnancy intrauterine pregnancy are improved,and the rate of re-ectopic pregnancy and abortion are reduced.