输卵管妊娠保留生育功能手术治疗与药物治疗的临床效果比较

Comparison of Clinical Efficacy of Surgical Treatment and Drug Therapy for Preserving Fertility Function in Ectopic Pregnancy

目的比较保留生育功能手术治疗与药物治疗的不同保守治疗方法对输卵管妊娠患者的临床效果。方法回顾性分析2015年1月—2020年12月福建省立医院妇科收治的200例输卵管妊娠患者的临床资料,根据保守治疗方法的不同分为保守性手术治疗组和药物治疗组,其中行保留生育功能手术治疗(腹腔镜开窗取胚术)的100例患者为保守性手术治疗组,行甲氨蝶呤联合米非司酮药物治疗的100例患者为药物治疗组。比较两组患者满意度、住院时间、治疗后血β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-hCG)水平及远期疗效。结果保守性手术治疗组患者的满意度高于药物治疗组,且保守性手术治疗组患者的住院时间短于药物治疗组(P<0.05);治疗后第1天保守性手术治疗组与药物治疗组血β-hCG水平比较,差异无统计学意义(P>0.05);治疗后第4、7天保守性手术治疗组血β-hCG水平低于药物治疗组(P<0.05);保守性手术治疗组血β-hCG降至正常时间较药物治疗组缩短(P<0.05)。保守性手术治疗组的患侧输卵管畅通率及自然宫内妊娠率高于药物治疗组(P<0.05);保守性手术治疗组的患侧输卵管重复妊娠率低于药物治疗组(P<0.05)。结论输卵管妊娠患者采用保留生育功能手术治疗较甲氨蝶呤联合米非司酮药物治疗临床效果更优。

Objective To compare the clinical effect of different conservative treatment methods of fertility preservation operation and drug therapy on tubal pregnancy.Methods The clinical data of 200 patients with ectopic pregnancy admitted to the department of gynecology,Fujian Provincial Hospital from January 2015 to December 2020 were retrospectively analyzed.According to different conservative treatment methods,they were divided into conservative surgical treatment group and drug treatment group.Among them,100 patients receiving fertility preservation surgery(laparoscopic fenestration)were classified as conservative surgical treatment group,and 100 patients receiving methotrexate combined with mifepristone were classified as drug treatment group.The satisfaction,length of hospital stay,β-human chorionic gonadotropin(β-hCG)level after treatment and long-term efficacy of the two groups were compared.Results The satisfaction rate of patients in the conservative surgical treatment group was higher than that in the drug treatment group,and the length of hospital stay in the conservative surgical treatment group was shorter than that in the drug treatment group(P<0.05).There was no significant difference in bloodβ-hCG level between the conservative surgical treatment group and the drug treatment group on day 1 after treatment(P>0.05).The bloodβ-hCG level in the conservative surgical treatment group was lower than that in the drug treatment group on day 4 and day 7 after treatment(P<0.05).The time for bloodβ-hCG fall to normal in conservative surgical treatment group was shorter than that in drug treatment group(P<0.05).The conservative operation group had higher patency of the affected fallopian tube and natural intrauterine pregnancy rate than the drug treatment group(P<0.05).The rate of retubal pregnancy of the affected fallopian tube in the conservative surgical treatment group was lower than that in the drug treatment group(P<0.05).Conclusion The treatment of ectopic pregnancy with fertility preservation operation is more effective than that of methotrexate combined with mifepristone.