对比药物终止妊娠保守治疗、腹腔镜下保留输卵管手术治疗及经腹保留输卵管手术治疗输卵管妊娠的疗效及患者生育结局

Comparative of the Efficacy of Conservative Medical Termination of Pregnancy,Laparoscopic Tubal-preserving Surgery and Tubal-preserving Tubal Surgery for Tubal Pregnancy

目的对比药物终止妊娠保守治疗、腹腔镜下保留输卵管手术及经腹保留输卵管手术治疗输卵管妊娠的疗效及患者生育结局。方法选择2018年1月至2019年12月纳入我院的78例输卵管妊娠病例样本,以动态随机分组法将其进行交叉分组,设置为药物组、腹腔镜组、经腹组,每组26例,分别给予药物终止妊娠保守治疗、腹腔镜下保留输卵管手术治疗、经腹保留输卵管手术治疗,对比分析疗效及生育结局。结果腹腔镜组血β-HCG水平复常时间、孕酮复常时间及住院时间均短于药物组、经腹组,且输卵管通畅率高于药物组、经腹组,差异有统计学意义,P<0.05;腹腔镜组不良反应发生率低于药物组、经腹组,差异有统计学意义,P<0.05;腹腔镜组宫内妊娠率高于药物组、经腹组,差异有统计学意义,P<0.05,3组再次异位妊娠率比较差异无统计学意义,P>0.05。结论针对输卵管妊娠患者,推荐采取腹腔镜下保留输卵管手术治疗。该种手术方式既能够更好改善血β-HCG水平、孕酮水平、促进输卵管再通,又可以提高宫内妊娠率,降低不良反应发生率。在实际治疗过程中,应综合患者实际情况选择最佳治疗方案。

Objective To comparatively analyze the efficacy of conservative medical termination of pregnancy,laparoscopic tubal-preserving surgery and trans-abdominal tubal-preserving surgery for tubal pregnancy,and the outcome of patients'fertility.Methods From January 2018 to December 2019,78 samples of tubal pregnancy cases in our hospital were selected,and the included samples were cross-grouped by the"dynamic random grouping method".The drug group,laparoscopic group,and transabdominal group were set up.In each group,26 cases were given conservative medical treatment for termination of pregnancy,laparoscopic tubal-preserving surgical treatment,and trans-abdominal tubal-preserving surgical treatment.The efficacy and fertility outcomes were compared and analyzed.Results The time of normalization of bloodβ-HCG level,progesterone,and hospitalization in the laparoscopic group were shorter than those in the drug group and transabdominal group,and the patency rate of the fallopian tubes was also higher than that in the drug group and transabdominal group,P<0.05;the incidence of adverse reactions in the laparoscopic group was lower than that in the drug group and transabdominal group,the difference was significant,P<0.05;the intrauterine pregnancy rate in the laparoscopic group was higher than that in the drug group and transabdominal group,P<0.05.The difference in the rate of re-ectopic pregnancy among the three groups was small,P>0.05.Conclusion For patients with tubal pregnancy,laparoscopy is recommended to preserve the fallopian tube.This surgical method can not only improve bloodβ-HCG level,progesterone level,promote fallopian tube recanalization,but also increase intrauterine pregnancy rate and reduce incidence of adverse reactions.In the actual treatment process should be based on the actual situation of the patient to select the best treatment plan.