腹腔镜下输卵管妊娠取胚后的重建术

目的通过与腹腔镜下输卵管取胚术比较,观察腹腔镜下输卵管妊娠取胚后重建术的临床疗效。方法 2007年5月-2010年5月,收治63例输卵管妊娠患者。30例行腹腔镜下输卵管妊娠取胚后重建术(试验组),33例行腹腔镜下输卵管妊娠取胚术(对照组)。两组患者年龄、妊娠时间、部位等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。术中及术后1个月行通液检查,术后2个月行输卵管碘油造影(hysterosalpingography,HSG)观察输卵管通畅度,记录患者术后妊娠情况。结果试验组手术成功29例;1例因严重粘连无法施行重建术,排除统计学分析。术中通液检查示,试验组输卵管全程通畅26例,对照组2例,差异有统计学意义(Z=5.86,P=0.00)。术后1个月通液检查示,试验组全程通畅25例、对照组26例,差异无统计学意义(Z=0.48,P=0.63)。术后2个月HSG检查示,试验组全程通畅25例,对照组2例,差异有统计学意义(Z=5.35,P=0.00)。术后24个月内试验组有25例(86.20%)宫内妊娠,显著高于对照组的19例(57.58%)(χ2=7.72,P=0.01)。结论腹腔镜下输卵管妊娠取胚后重建术显著提高了宫内妊娠率,疗效优于腹腔镜下输卵管取胚术。

CLINICAL APPLICATION OF TUBAL RECONSTRUCTION AFTER LAPAROSCOPIC TUBAL PREGNANCY OPERATION

Objective To investigate the effectiveness of the tubal reconstruction after laparoscopic tubal pregnancyoperation by comparing with simple laparoscopic tubal pregnancy operation.Methods Between May 2007 and May 2010,63 patients with tubal pregnancy underwent laparoscopic tubal pregnancy operation and tubal reconstruction in 30 cases(trialgroup) or simple laparoscopic tubal pregnancy operation in 33 cases(control group).There was no significant diff erence inage,pregnancy time,and position between 2 groups(P > 0.05).The tube patency test and hysterosalpingography(HSG) werecarried out to evaluate the efficacy.Results The operation was successfully completed in 29 cases of trial group;1 case hadtoo severe adhesion to receive re-anastomosis and was excluded.The tube patency test showed that the tube was patency in 26cases of trial group and in 2 cases of control group during operation,showing significant diff erence(Z=5.86,P=0.00);it waspatency in 25 cases of trial group and in 26 cases of control group at 1 month after operation,showing no significant diff erence(Z=0.48,P=0.63).HSG examination showed tube was patency in 25 cases of trial group and in 2 cases of control group at2 months after operation,showing significant diff erence(Z=5.35,P=0.00).After 24 months,intrauterine pregnancy of trialgroup(n=25,86.20%) was significantly higher than that of control group(n=19,57.58%)(χ2=7.72,P=0.01).Conclusion Thereconstruction after laparoscopic tubal pregnancy operation can significantly increase the intrauterine pregnancy rate,and it isbetter than simple laparoscopic tubal pregnancy operation.