保留输卵管对腹腔镜辅助下输卵管妊娠患者术后生育的影响

目的：探讨保留输卵管是否对腹腔镜辅助下输卵管妊娠患者术后生育产生影响。方法选取2008年10月至2010年12月我院妇产科收治的148例被确诊为输卵管妊娠的患者，随机分为保留组和切除组各74例，保留组行输卵管保留手术，切除组行患侧输卵管切除术。通过随访比较两组患者术后继发性不孕、再次异位妊娠、宫内妊娠、术后第一年生育等妊娠情况及术后1年、术后2年累积不孕率情况。根据随访结果将患者分为宫内妊娠组、再次异位妊娠组及继发不孕组三组，每组例数分别为81例、19例和48例，主要观察不同妊娠结局的临床特点。结果保留组和切除组患者术后继发性不孕、再次异位妊娠、宫内妊娠、术后第一年生育等妊娠情况及术后1年、术后2年累积不孕率等情况相比较差异均无统计学意义（P＞0.05）。宫内妊娠组、再次异位妊娠组及继发不孕组患者的输卵管形态异常率分别为13.58%、84.21%、87.5%；盆腔粘连分别为23.46%、73.68%、64.58%；输卵管通畅分别为93.83%、47.37%、25%，组间比较差异均有统计学意义（P＜0.05）。结论保留输卵管能否有效提高输卵管妊娠患者术后的生育能力仍然需要根据患者的具体病情具体分析，对于健侧输卵管异常、盆腔粘连比较严重或者已有一侧输卵管切除术病史且有强烈生育愿望的患者，建议选择腹腔镜输卵管保留术进行治疗。

Fertility outcome of conservation operation in tubal pregnancy with laparoscopic surgery

Objective To investigate the outcome of conservation operation in tubal pregnancy with laparo-scopic surgery. Methods One hundred and fourty-eight patients with tubal pregnancy admitted to our hospital from October 2008 to December 2010 were selected and randomly divided into conservation group and resection group with 74 cases in each one. Patients in conservation group were kept fallopian tube, and in resection group the affected fallopian tube was removed. After following-up, postoperative secondary infertility, reoccurrence of ectopic pregnan-cy, intrauterine pregnancy, birth in the first year after surgery, and the cumulative infertility rate in 1 and 2 years after surgery were evaluated. According to the results of following-up, patients were divided into intrauterine pregnancy group, ectopic pregnancy again group and secondary infertility group with 81 cases, 19 cases and 48 cases, respective-ly. The clinical features in different pregnancy outcome were observed. Results There was no difference between conservation group and resection group in postoperative secondary infertility, reoccurrence of ectopic pregnancy, intra-uterine pregnancy, and birth in the first year after surgery （P〉0.05）. Tubal morphological abnormalities rates in intra-uterine pregnancy group, ectopic pregnancy again group and secondary infertility group were 13.58%, 84.21%, 87.5%, respectively. Pelvic adhesions rates were 23.46%, 73.68%, and 64.58%, respectively. And tubal patency rates were 93.83%, 47.37% and 25%, respectively. The differences among the three groups were statistically significant （P〈0.05）. Conclusion Whether the conservation surgery could improve the fertility depended on the condition of pa-tients. For patients with contralateral tubal abnormalities, pelvic adhesions, previous salpingectomy or strong desire for fertility, conservation laparoscopic surgery was recommended.