输卵管妊娠患者腹腔镜保守性手术后生育状况及其影响因素分析

目的观察腹腔镜保守性手术治疗输卵管妊娠后患者生育状况并探讨其影响因素。方法对2001年1月至2004年5月佛山市第一人民医院接受腹腔镜保守性手术治疗的162例输卵管妊娠患者（A组）,观察其术后输卵管通畅程度、再次宫内妊娠率、异位妊娠再发等情况,并与同期接受输卵管大部分切除的96例患者（B组）进行对比分析;采用Logistic回归分析术前血人绒毛膜促性腺激素（HCG）水平等因素对术后生育结局的影响。结果腹腔镜保守性手术组与患侧输卵管大部分切除术组术后持续性异位妊娠发生率分别为8.02%、1.04%;随访2～5年,保守性手术组和患侧输卵管大部分切除术组再次宫内妊娠率分别为71.6%、38.5%,两组比较差异有统计学意义（P〈0.05）。在单因素分析中,腹腔镜保守性手术治疗输卵管妊娠术后宫内妊娠率分别与术前血HCG水平、包块大小、盆腔粘连情况、患侧输卵管破裂与否、对侧输卵管闭锁与否、术后患侧或对侧输卵管通畅与否、既往异位妊娠病史相关（P〈0.05）;在多因素分析中,术后宫内妊娠率与术前血HCG水平、盆腔粘连情况、患侧输卵管术后通畅与否、既往异位妊娠病史相关（P〈0.05）。结论腹腔镜保守性手术治疗输卵管妊娠具有微创、安全及再次宫内妊娠率高等优点。术前血HCG水平、盆腔粘连情况、患侧输卵管术后通畅与否、既往异位妊娠病史是影响术后宫内妊娠率的相对独立因素。对于严重盆腔粘连或重复同侧输卵管妊娠者,不建议行保守性手术。

Analysis of the reproductive performance and its affected factors after laparoscopic oviduct-sparing surgical treatment of tubal pregnancy

Objective To investigate into the reproductive performance after laparoscopic oviduct-sparing operation for tubal pregnancy,and to analyse the influential factors of the reproductive outcome.Methods A prospective study was carried out to compare the rate of post-operative oviduct patency,re-pregnancy and re-ectopic pregnancy in laparoscopic oviduct-sparing operation group(group A:162 cases)with that in laparoscopic salpingectomy group(group B:96 cases)in treating tubal pregnancy.Results The rate of post-operative persistent ectopic pregnancy(PEP),re-pregnancy in group A was 8.02%,71.6 % respectively,and that in group B was 1.04%,38.5% respectively.The rate of re-pregnancy was significantly different between group A and group B(P<0.05).But no significant difference was found in the rate of re-ectopic pregnancy(P>0.05).In the single factor analysis,the reproductive outcome in group A was significantly associated to the pre-operative serum level of HCG,the size of adnexal mass,pelvic adhesion,rupture of affected oviduct,patency of the contra-lateral oviduct,history of ectopic pregnancy,and the post-operative patency of the contra-lateral oviduct as well as the affected oviduct(P<0.05).In multi-factors analysis,the reproductive outcome in group A was related to the pre-operative serum level of HCG,pelvic adhesion,the history of ectopic pregnancy as well as post-operative patency of the affected oviduct(P<0.05).Conclusion Laparoscopic oviduct-sparing operation in treatment of tubal pregnancy is safe and mini-invasive,and has advantage of higher re-pregnancy.Each of the pre-operative serum level of HCG,pelvic adhesion,the patency of affected oviduct and the history of ectopic pregnancy is an independent factor that affects the post-operative fertility.The oviduct-sparing operation is not recommended for those patients with extensive pelvic adhesion or same side re-ectopic pregnancy.