3种保守方式治疗输卵管妊娠的疗效及预后

目的探讨3种保守治疗方法治疗输卵管妊娠的疗效及对患者预后的影响。方法回顾性分析189例年龄〈35岁，有生育要求的输卵管妊娠患者的临床资料，其中43例行腹腔镜下输卵管取胚术，再予MTX 20mg输卵管局部注射（腹腔镜联合药物组，G1）；69例行单纯腹腔镜下输卵管取胚术（腹腔镜组，G2）；77例行药物MTX（50mg／m^2）单次肌肉注射（药物组．G3）。观察3组治疗后持续性异位妊娠发生情况及患侧输卵管通畅情况，比较3组2年内宫内妊娠、重复异位妊娠、继发不孕情况以及宫内妊娠后早期流产发生率。结果3组持续性异位妊娠发生率明显不同，差异有统计学意义，最高为G3组（28．9％），G2组次之（8．7％），G1组无1例发生，但两手术组比较差异无统计学意义。3组治疗后患侧输卵管通畅情况提示两手术组通畅率明显高于药物组，差异有统计学意义，G1、G2组比较差异无统计学意义。治疗后随访2年3组的宫内妊娠率、重复异位妊娠率及继发不孕率差异均无统计学意义；两手术组的宫内妊娠率高于G3组，重复异位妊娠率及继发不孕率低于G3组，差异有统计学意义；宫内妊娠后的自然流产率3组比较差异无统计学意义。结论对于有生育要求的年轻输卵管妊娠患者，腹腔镜下保留输卵管手术是首选的治疗方式，其疗效确切，副作用小，对术后生育能力的保护较好。

Efficacy and prognosis of three kinds of conservative treatment of tubal pregnancy

Objective To investigate the effect and prognosis of three kinds of conservative treatment of tubal pregnancy. Methods The clinical and follow-up data of 189 patients who were younger than 35 years old and have fertility requirements with tubal pregnancy were analyzed retrospectively. They were divided into three groups. 43 patients were treated with conservative laparoscopic surgery combined with 20mg injection of methotrexate （ Group 1 ） ; 69 patients were treated with simple conservative laparoseopic surgery （ Group 2） ,77patients were treated with simple injection of methotrexate （Group 3）. Persistent ectopie pregnancy rate and patency rate of the fallopian tube after treatment in the three groups were observed.The intrauterine pregnancy, ectopic pregnancy and infertility were compared after followed up for two years and the natural abortion rate after intrauterine pregnancy. Results The persistent ectopie pregnancy rate showed a significant difference in three groups, in which the highest one was Group 3 （28.9%） , the second one was Group 2 （8.7%） and there was no cases in the Group 1. The patency rate of the fallopian tube was no significant difference in two operation groups, but both groups were obviously higher than that of the drug group. Intrauterine pregnancy rate and repeat ectopic pregnancy rate in the Group 1 were higher, but secondary infertility rate was lower, than that in the Groun 2. and the difference wns not statistically significant. Intrauterine pregnancy rate of two operation groups were significantly higher than that of the drug group, secondary infertility rate and repeated ectopic pregnancy rate were lower than that of the drug group, and the difference was statistically significant. The natural abortion rate after intrauterine pregnancy was no significant difference in three groups. Conclusion For young patients having fertility requirements with tubal pregnancy, the treatment with conservative laparoscopic surgery to retain oviduct is better option which shows the curative effect, little side effect and the better protection for fertility.