腹腔镜下保守手术与腹腔镜下输卵管切除术治疗输卵管妊娠的对照研究

目的：比较腹腔镜下保守手术与腹腔镜下输卵管切除术治疗输卵管妊娠的临床效果。方法方便选取该院2010年1月—2013年1月收治的90例输卵管妊娠患者根据有无生育要求以及患者的病情分为A组（51例）与B组（39例）两组,A组行腹腔镜下保守手术治疗,B组行腹腔镜下输卵管切除术,比较两组患者的手术时间、术中出血量、住院时间、血β-HCG转阴时间以及随访妊娠情况。结果 A组患者手术时间、术中出血量明显大于B组（P<0.01）；两组住院时间、血β-HCG转阴时间比较差异无统计学意义（P>0.05）；经2年随访,A组宫内妊娠率为43.14%,B组为20.51%,A组明显高于B组（P<0.05）；A组未孕率为41.18%,B组为66.67%,A组明显低于B组（P<0.05）；两组异位妊娠率比较则差异无统计学意义（P>0.05）。结论与腹腔镜下输卵管切除术相比,腹腔镜下保守手术治疗输卵管妊娠可保留患者生育功能,再次妊娠率及宫内妊娠率高；但对于患侧严重输卵管损坏而对侧输卵管正常以及严重盆腔粘连者则建议行腹腔镜下输卵管切除术治疗,以减少再次异位妊娠的发生。

Comparative Study of Laparoscopic Conservative Surgery and Laparoscopic Tubal Resection in the Treatment of Tubal Pregnancy

Objective To compare the clinical effect of laparoscopic conservative surgery and laparoscopic tubal resection in the treatment of tubal pregnancy. Methods Convenient selection 90 cases of patients with tubal pregnancy in our hospital from January 2010 toJanuary 2013 were selected, according to the requirements of the birth of patients ,they were divided into group A (51 cases) and group B (39 cases). Group A was given laparoscopic conservative surgery, and group B was giv-en laparoscopic tubal resection, operative time, bleeding volume, operation time, blood beta -HCG clearance time and fol-low-up of pregnancy of two groups were compared. Results The operation time of group A was significantly higher than that of group B (P<0.01);There were no significant differences in hospitalization time, the serum beta -HCG clearance time be-tween two groups (P>0.05);They were followed up for two years , the intrauterine pregnancy rate of group A was 43.14%, and the group B was 20.51%, group A was significantly higher than that of group B (P<0.05); The no pregnancy rate of group A was 41.18%, and the group B was 66.67%, group A was significantly lower than that of group B (P<0.05); There was no significant difference in the rate of ectopic pregnancy between the two groups (P>0.05). Conclusion Compared with laparoscopic tubal resection, laparoscopic conservative surgery in the treatment of tubal pregnancy can retain the function of fertility, the rate of pregnancy and intrauterine pregnancy rate are high; However, it is recommended to give laparoscopic tubal resection in the treatment of patients with the serious damage of the affected side of fallopian tube and the normal side of the fallopian tube and severe pelvic adhesion , in order to reduce the occurrence of ectopic pregnancy again.