输卵管部分切除术联合端端吻合术影响患者输卵管通畅性和妊娠的相关因素分析

Risk factors for tubal patency and their impact on pregnancy rate after partial salpingectomy and end-to-end anastomosis

目的:探讨输卵管部分切除术联合端端吻合术后影响患者输卵管通畅性和妊娠的风险因素。方法:选取2020年1月至2023年4月郑州市妇幼保健院300例输卵管妊娠患者,所有患者均行输卵管部分切除术联合端端吻合术,并于术后行子宫输卵管造影检查。对患者术后输卵管的通畅性进行统计分析,并采用Lasso-Logistic回归分析术后输卵管通畅性的风险因素,Spearman相关性分析法分析各风险因素与术后妊娠的关系。结果:300例患者中输卵管通畅225例(通畅组),输卵管通而不畅54例及输卵管堵塞21例(不通畅组)。单因素分析结果显示,年龄、输卵管孕囊直径、输卵管妊娠部位、手术时机、盆腔粘连、吻合术方式、剩余输卵管长度、盆腔手术史、术中电凝输卵管部位的次数(以下简称术中电凝次数)、术中出血量、手术医生工作年限是术后输卵管通畅性的影响因素(均P<0.01);Lasso回归分析进一步筛选出7个影响因素:输卵管妊娠部位、盆腔粘连、吻合术方式、剩余输卵管长度、盆腔手术史、术中电凝次数、手术医生工作年限;Logistic回归分析结果显示,输卵管峡部妊娠、盆腔粘连、开腹吻合术、盆腔手术史、术中电凝次数是术后输卵管通畅性的独立危险因素,剩余输卵管长度、手术医生工作年限是术后输卵管通畅性的独立保护因素(均P<0.01)。研究随访1年,失访5例。295例患者中,术后1年妊娠192例(65.08%),其中宫内妊娠172例(89.58%),异位妊娠20例(10.42%)。Spearman相关性分析结果显示,输卵管峡部妊娠、盆腔粘连、开腹吻合术、盆腔手术史、术中电凝次数与术后妊娠呈负相关,剩余输卵管长度、手术医生工作年限与术后妊娠呈正相关(均P<0.01)。结论:输卵管峡部妊娠、盆腔粘连、开腹吻合术、盆腔手术史、术中电凝次数是影响输卵管部分切除术联合端端吻合术后患者输卵管通畅性的独立危险因素,且与术后妊娠呈负相关;剩余输卵管长度、手术医生工作年限是影响输卵管部分切除术联合端端吻合术后患者输卵管通畅性的独立保护因素,且与术后妊娠呈正相关。

Objective:To explore the risk factors for tubal patency after partial salpingectomy and end-to-end anastomosis,and their impact on pregnancy outcomes.Methods:A total of 300 patients with tubal pregnancy who underwent partial salpingectomy and end-to-end anastomosis in Zhengzhou Maternal and Child Health Hospital from January 2020 to April 2023 were enrolled in the study.Hysterosalpingography was performed after surgical treatment to examine the tubal patency.Lasso-Logistic regression was used to analyze the risk factors for postoperative tubal patency,and Spearman’s correlation was used to analyze the impact of each risk factor on the pregnancy rate.Results:Hysterosalpingography showed that the fallopian tube was not obstructed in 225 cases(unobstructed group),the tube was not completely patent(n=54)or blocked(n=21)(obstructed group).Univariate analysis showed that age,diameter of the tubal pregnancy sac,location of tubal pregnancy,timing of surgery,pelvic adhesion,anastomotic method,length of remaining tubal,history of pelvic surgery,number of intraoperative electrocoagulation,intraoperative blood loss,and experience of surgeons were factors affecting postoperative tubal patency(all P<0.01).Lasso regression analysis identified location of tubal pregnancy,pelvic adhesion,anastomotic method,length of remaining tubal,history of pelvic surgery,number of intraoperative electrocoagulation,and experience of surgeons as influencing factors.Multivariate Logistic regression analysis showed that tubal isthmus pregnancy,pelvic adhesion,open anastomosis surgery,history of pelvic surgery,and number of intraoperative electrocoagulation were independent risk factors for postoperative tubal patency,while length of remaining tubal and years of surgeon’s work experience were independent protective factors for postoperative tubal patency(all P<0.01).A total of 295 patients were followed up for 1 year,192 cases(65.08%)were pregnant,including 172 cases of intrauterine pregnancy(89.58%)and 20 cases of ectopic pregnancy(10.42%).Spearman correlation analysis showed that tubal isthmus pregnancy,pelvic adhesion,open abdominal anastomosis surgery,pelvic surgery history,and times of intraoperative electrocoagulation were negatively correlated with postoperative pregnancy,while the remaining tubal length and years of surgeon’s working experience were positively correlated with postoperative pregnancy rate(all P<0.01).Conclusions:For tubal patency of patients after partial salpingectomy combined with end-to-end anastomosis,the history of tubal isthmus pregnancy,pelvic adhesion,open abdominal anastomosis,pelvic surgery,and the number of intraoperative electrocoagulation are independent risk factors,which are negatively correlated with postoperative pregnancy.The remaining tubal length and the years of surgeon’s work experience are independent protective factors,which are positively correlated with postoperative pregnancy.